Evaluations of cardiovascular diseases with hybrid PET-CT imaging
Yi-Hwa Liu, Albert J. Sinusas in Hybrid Imaging in Cardiovascular Medicine, 2017
Figure 15.4 shows an example of balanced three-vessel disease detected by hybrid PET-CTA. The patient was a 52-year-old female with a history of typical angina pectoris. Myocardial perfusion was evaluated with PET and 15O-water during adenosine stress. Images show polar maps of myocardial perfusion with relative normalization to the maximum (Figure 15.4a) or absolute scale from 0 to 3.5 mL/g/min (Figure 15.4b). Relative perfusion within the LAD, LCX, and RCA territories was normal (100%, 100%, and 83% of the maximum, respectively), whereas absolute MBF quantification shows severe, balanced reduction of perfusion within all territories (0.75–0.9 mL/g/min; normal value, >2.3 mL/g/min). Coronary CTA revealed the reason for the reduced perfusion. There was a severe stenosis in the left main coronary artery caused by a soft plaque, as shown in Figure 15.4c (arrow), and another calcified lesion causing luminal narrowing in the middle RCA, shown in Figure 15.4d (arrow). Invasive coronary angiography confirmed the findings and the patient was referred for coronary artery bypass surgery.
Cardiac tests and procedures
Clive Handler, Gerry Coghlan, Nick Brown in Management of Cardiac Problems in Primary Care, 2018
Coronary artery bypass surgery is generally advised in patients who are unsuitable for coronary angioplasty, which is equally effective in relieving angina. Repeat revascularisation is more likely to be required in patients who have had angioplasty, because of the risks of restenosis, which are lower with the use of stents and particularly coated stents. Coronary artery surgery is preferred to angioplasty in patients with severe triple-vessel coronary artery disease and left ventricular impairment, because it confers the added advantage of improving prognosis as well as symptoms. In patients for whom no prognostic benefit is expected and in whom coronary artery surgery is considered too high a risk or is refused, coronary angioplasty is considered. All patients with coronary artery disease should have cardiovascular risk factor evaluation and treatment.
A New Perspective Into Affordable, Quality Healthcare: The Case of Pronto Care
Frederick J. DeMicco, Ali A. Poorani in Medical Travel Brand Management, 2023
A good clinical example is focusing on the (Mechanical) approach to treat Coronary Artery Disease by using Balloon Angioplasty or implanting Coronary Stents as a spot-fix and focusing on the mechanical part such as choosing the proper wire type to cross the stenosis (blockage), which guiding catheter to use, which device to use to de-bulk the lesion to make room for the stent (metal mesh used as a scaffold to keep artery patent) to be implanted and prevent the arterial re-narrowing (recoil) which happens frequently after using POBA (Plain Old Balloon Angioplasty). Then the choice of stent mostly now drug-coated with a polymer that prevents cellular replication (endothelial hyperplasia), which is another mechanism leading to re-narrowing of the artery at the stented segment with recurrence of symptoms of Angina (Effort-induced Chest Pain, relieved with rest.) That is mostly done without addressing the entire arterial tree as if stents were inappropriately implanted, this will create a new disease which may require additional stents leading to eventual need for Coronary Artery Bypass Surgery after failed (full-metal jacket) of multiple stents placed. This can also lead to repeated Angina attacks, heart attacks, and subsequent Congestive Heart Failure, adding to already high-cost healthcare bill. Even after Bypass surgery, the bypass grafts can get clogged with further stents placed, which may fail leading to a redo Coronary Artery Bypass Surgery in few years due to progression of coronary artery disease!
An entire coronary system arising from right coronary cusp: a rare anomaly
Published in Journal of Community Hospital Internal Medicine Perspectives, 2019
Muhammad Shabbir Rawala, Syed Imran Rizvi, Syed Bilal Rizvi
Our patient did not have any obstructive coronary artery disease but still was having symptoms on exercise possibly due to the mechanisms described above. There are no general guidelines to manage this particular CAA; however, due to the association of SCD with anomalous artery and exercise, patients are generally advised to avoid strenuous activity. The management of coronary artery disease in the setting of CAA include medical management, percutaneous coronary intervention (PCI) or surgical repair [5]. PCI is generally complex and technically demanding in these anomalous arteries due to its angulation from aorta, ostial configuration, site of atherosclerotic lesion and the course of the artery [10]. Cardiac surgery includes direct repair of origin of the anomalous artery in the aortic root and coronary artery bypass surgery (CABG). CABG is more feasible; however, it also has limitations due to the longevity of the grafts [6].
Tubular basement membrane amyloid deposition: is it an indicator of renal progression in light chain amyloidosis?
Published in Renal Failure, 2023
Csilla Markóth, László Bidiga, László Váróczy, Ibolya File, József Balla, János Mátyus
A 69-year-old male patient had a myocardial infarction in 2002, and a history of kidney stones, Lyme disease, prostate hyperplasia, fatty liver, and diabetes mellitus. In February 2016, he was admitted to the nephrology department due to a decrease to 19 ml/min/1.73 m2 in eGFR and nephrotic syndrome with a uPCR level of 1332 mg/mmol. An increased sFLCk/l value of 7 was verified without detectable monoclonal components in the SPEP. Renal histology revealed one sclerotic glomerulus and 18 glomeruli with extensive kappa restriction with PAS-negative, Congo red positive and apple green birefringent material in the mesangium, efferent, afferent, and smaller arterioles. IFTA was 50%. EM confirmed the presence of 8–12 nm wide amyloid fibrillar structure in the TBM also. Bone marrow biopsy revealed a 10% plasma cell infiltration; FISH was negative, confirming monoclonal gammopathy of renal significance as a cause of kappa LA. The patient had no extrarenal involvement. Chemotherapy was initiated; however, unstable angina developed before the second cycle. Urgent coronarography and coronary artery bypass surgery were performed; however, the patient died three days later.
Surgical Outcome of Infective Aortic Valve Endocarditis Involving Valve Annulus. Comparison between Native Valve Endocarditis and Prosthetic Valve Endocarditis
Published in Structural Heart, 2019
Tomofumi Fukuda, Kazuyoshi Takagi, Koichi Arinaga, Tohru Takaseya, Takahiro Shojima, Yasuyuki Zaima, Hiroyuki Saisyo, Atsunobu Oryoji, Hiroyuki Tanaka
Results: The mean age was 59.1 and 70.7 years old in NVE and PVE, respectively. In bacterial examination, Streptococcus endocarditis was common in NVE and Staphylococcus endocarditis was common in PVE. Estimated mortality using Euro II was 27.7% in NVE and 32.9% in PVE. In NVE, 9 patients underwent aortic valve replacement (AVR) with annular patch reconstruction and 2 patients underwent AVR with direct annular closure after complete debridement. The extended annular involvement was observed in most patients in PVE. Complicated surgical procedures were required for complete resection of infective tissue. Left ventricular outflow tract reconstruction with aortic root replacement (ARR) was required in 3 patients. Conventional ARR was performed in 5 patients. Five patients required concomitant coronary artery bypass surgery. Operative mortality was 18.2% in NVE and 6.7% in PVE. The overall survival (excluding operative deaths) at 1 and 5 years were 88.9%, 77.8% and 92.9%, 92.9% in NVE and PVE, respectively. Recurrence of infective endocarditis has been observed in one patient of PVE, 3 years after operation. There is no significant difference on the long-term survival and the freedom from recurrence of infection between groups.
Related Knowledge Centers
- Angina
- Coronary Artery Disease
- Great Saphenous Vein
- Stenosis
- Ischemia
- Cardiopulmonary Bypass
- Surgical Anastomosis
- Left Anterior Descending Artery
- Anatomy of The Human Heart
- Radial Artery