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Deaths Following Cardiac Surgery and Invasive Interventions
Published in Mary N. Sheppard, Practical Cardiovascular Pathology, 2022
Post-myocardial infarction VSD is an uncommon but frequently fatal complication, occurring in fewer than 1% of patients sustaining myocardial infarction in the modern era of early reperfusion therapy. Despite significant improvements over the last two decades in overall mortality for acute MI, the outcome of patients who develop VSD remains poor. Mortality rates exceed 90% with medical therapy. Data from the STS registry (2876 patients) showed an overall operative mortality of 42.9%, representing the highest risk of all cardiac procedures recorded in the database. A wider use of LVADs as a bridge to surgery or post-repair support may contribute in improving the current poor outcome of ischaemic VSDs, particularly for patients requiring emergency surgery. Small or medium VSDs can be treated definitively with a ventricular septal occluder initially to stabilize patients and allow myocardial fibrosis, thus facilitating delayed subsequent surgical correction. The defects are usually located posteroapically. Closure is affected by direct suture, usually over pledgets of felt or similar material (Fig. 9.32). A frequent finding is occlusion of the proximal part of the posterior descending coronary artery in individuals with poor or absent collateral circulation. Thus, people with dominant left coronary artery are especially at risk, as are those with previous anterolateral or apical infarction.
Thorax
Published in Bobby Krishnachetty, Abdul Syed, Harriet Scott, Applied Anatomy for the FRCA, 2020
Bobby Krishnachetty, Abdul Syed, Harriet Scott
Left coronary artery RAO caudalLAO caudalRAO cranialLAO cranialLAO straight
Functions of the Cardiovascular System
Published in Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal, Principles of Physiology for the Anaesthetist, 2020
Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal
The left coronary artery arises from the posterior aortic sinus and supplies blood to the left ventricle and left atrium. The left main coronary divides into branches: The left anterior descending artery branches off the left coronary artery and supplies blood to the front of the left side of the heart. It passes along the anterior interventricular groove towards the apex, turns round the inferior border of the heart and anastomoses with the posterior interventricular artery.The circumflex artery branches off the left coronary artery and encircles the heart muscle around the left heart border to anastomose with the posterior interventricular artery. This artery supplies blood to the left atrium and the side and back of the left ventricle.
Decision making in anomalous aortic origin of a coronary artery
Published in Expert Review of Cardiovascular Therapy, 2023
Hitesh Agrawal, Alexandra Lamari-Fisher, Keren Hasbani, Stephanie Philip, Charles D. Fraser, Carlos M. Mery
There are limited data on risk stratification of these patients. Anomalous left coronary artery accounts for 85% of all AAOCA associated SCD, with a few related to anomalous right coronary artery [7,12,15]. The lack of long-term data on repaired and unrepaired anomalous coronary arteries makes the management of these patients even more challenging. This is highlighted in a very simplistic way in the most recent statement from the AHA/ACC on AAOCA patients [27]. It considers any anomalous left coronary artery from the opposite sinus with an interarterial course as high risk, irrespective of symptoms or the presence of ischemia on stress test, whereas anomalous right is considered high risk only in the presence of symptoms or signs of ischemia on stress test. Several reports, however, have confirmed that the frequency of a negative stress test even in patients who have suffered SCD is not insignificant [7].
Platelet adhesion potential estimation in a normal and diseased coronary artery model: effects of shear stress magnitude versus shear stress history
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2022
Coronary heart disease (CHD) claims the most lives in the United States annually and accounts for more than 50% of all cardiovascular associated deaths (Lloyd-Jones et al. 2010). It has previously been shown that biochemical and mechanical factors play a role in CHD development, including high plasma cholesterol and altered shear stress (Schwenke and Carew 1989b, Schwenke and Carew 1989a; Cunningham and Gotlieb 2005). The coronary arteries are common sites for altered shear stress due to the complex three dimensional geometry of the vessels (Dodge Jr. et al. 1992). Furthermore, the left coronary artery is a common site for atherosclerotic lesion growth, which alters the normal blood flow to such a significant extent that the flow becomes pathological. During most CHDs, not only are mechanical cues altered but biological cues can also be modified. One common observation due to these altered cues is that there is an increase in the adhesion between platelets and endothelial cells, two salient cells for CHD. Many groups have shown that endothelial cell and platelet functions, including adhesion, are altered under disturbed blood flow conditions (Chien 2008; Rubenstein and Yin 2010; Yin et al. 2011). However, these functional changes are generally not included in numerical models of cardiovascular diseases. Therefore, it is important to develop an accurate predictive model of platelet and endothelial cell functional changes in response to altered shear stress in the left coronary artery.
Giant right coronary artery aneurysm fistulising to the superior vena cava
Published in Acta Cardiologica, 2021
Luis E. Lezcano-Gort, Zineb Kounka, Imara Herrera-Denis, Benjamín Roque-Rodríguez, María V. Mogollón-Jiménez, Sergio Moyano-Calvente
A 78-year-old woman was referred to our service by her primary care physician with exertional chest pain, progressive dyspnoea, and a heart murmur. Her medical record was relevant for hypertension, dyslipidemia, and permanent atrial fibrillation. Physical examination revealed a loud continuous murmur at the left sternal border. On transthoracic echocardiography, unusual flow originating from the right sinus of Valsalva was noted, and confirmed with transesophageal echocardiography (Figure 1(A)). Coronary angiography showed normal left coronary artery, and selective catheterisation of the right coronary artery was not successful. However, this artery was filled from the left coronary artery. Aortography revealed a giant para-aortic aneurysm (Figure 1(B)). Oximetry showed increased oxygen saturation at the lower end of the superior vena cava, and the QP/QS ratio was calculated at 3.5:1. Computed tomography scan with 3D volume-rendering reconstruction showed a giant aneurysm (diameter 7 cm) arising from the proximal segment of the right coronary artery, and fistulising to the superior vena cava (Figure 1(C–E)). Surgical intervention successfully resected the aneurysm and closed the fistula (Figure 1(F)).