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Funtional significance of the intermediate lesion in a single coronary artery assessed by fractional flow reserve.

Ha SJ, Kwon SH, Kim SJ - Korean J. Intern. Med. (2014)

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, Korea.

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To the Editor, Congenital coronary artery anomalies are infrequently seen during coronary angiographic study, reportedly occurring in 0.64% to 1.3% of patients... A resting electrocardiogram demonstrated a convex-shaped ST-segment elevation in the precordial lead without reciprocal change... Laboratory findings including cardiac markers showed no abnormalities... To decide the functional significance of the stenosis in the distal LCx artery, we performed an FFR study with a pressure wire and found that there was no critical functional stenosis (FFR, 0.9) (Fig. 2D)... A single coronary artery is an extremely rare congenital anomaly characterized by a single coronary artery ostium from an aortic sinus, and is seen in only 0.024% to 0.066% of patients who undergo conventional coronary angiography... A single coronary artery is usually asymptomatic and has a benign course, and these patients have a normal life expectancy... FFR is a physiologic parameter that can be readily measured during the invasive procedure and can evaluate the functional significance of coronary stenosis... In particular, FFR plays an important role when making a decision for percutaneous coronary intervention (PCI) of angiographically moderate stenosis and assessing accurately the functional consequences of a given coronary stenosis with unclear hemodynamic significance... In addition, the clinical outcome of patients in whom PCI is deferred because FFR indicated no hemodynamically significant stenosis was very favorable... With FFR, we could make a decision for deferred PCI and choose medical treatment, even though coronary CT angiography and coronary angiography showed moderate stenosis in the LCx artery... In conclusion, FFR could successfully evaluate the functional significance of a moderate stenotic lesion in a single coronary artery where the RCA originated from the terminal portion of the LCx artery.

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Coronary computed tomography (CT) angiography findings. (A, B) Volume rendering CT imaging and (C) multiplanar reformation image showed a single coronary artery in which the right coronary artery (RCA) originated from a branch of the left circumflex (LCx) artery with minimal possibility of chronic total occlusion of the RCA ostium with collateral supply from the LCx artery.
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Figure 1: Coronary computed tomography (CT) angiography findings. (A, B) Volume rendering CT imaging and (C) multiplanar reformation image showed a single coronary artery in which the right coronary artery (RCA) originated from a branch of the left circumflex (LCx) artery with minimal possibility of chronic total occlusion of the RCA ostium with collateral supply from the LCx artery.

Mentions: A 63-year-old man was admitted to the cardiology unit with atypical chest pain. He had hypertension as coronary heart disease risk factor. His vital signs were stable, and physical examination showed no abnormalities. A resting electrocardiogram demonstrated a convex-shaped ST-segment elevation in the precordial lead without reciprocal change. Laboratory findings including cardiac markers showed no abnormalities. Echocardiography revealed normal left ventricular morphology, no regional wall motion abnormality, and a diastolic dysfunction of relaxation abnormality. The patient underwent coronary computed tomographic (CT) angiography. It demonstrated the presence of a single coronary artery with the LCx artery continuing in the course of the RCA and minimal possibility of chronic total occlusion (CTO) of the RCA ostium with a collateral supply from the LCx artery (Fig. 1). It also showed 60% diameter stenosis in the distal LCx artery (Fig. 1).


Funtional significance of the intermediate lesion in a single coronary artery assessed by fractional flow reserve.

Ha SJ, Kwon SH, Kim SJ - Korean J. Intern. Med. (2014)

Coronary computed tomography (CT) angiography findings. (A, B) Volume rendering CT imaging and (C) multiplanar reformation image showed a single coronary artery in which the right coronary artery (RCA) originated from a branch of the left circumflex (LCx) artery with minimal possibility of chronic total occlusion of the RCA ostium with collateral supply from the LCx artery.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4219973&req=5

Figure 1: Coronary computed tomography (CT) angiography findings. (A, B) Volume rendering CT imaging and (C) multiplanar reformation image showed a single coronary artery in which the right coronary artery (RCA) originated from a branch of the left circumflex (LCx) artery with minimal possibility of chronic total occlusion of the RCA ostium with collateral supply from the LCx artery.
Mentions: A 63-year-old man was admitted to the cardiology unit with atypical chest pain. He had hypertension as coronary heart disease risk factor. His vital signs were stable, and physical examination showed no abnormalities. A resting electrocardiogram demonstrated a convex-shaped ST-segment elevation in the precordial lead without reciprocal change. Laboratory findings including cardiac markers showed no abnormalities. Echocardiography revealed normal left ventricular morphology, no regional wall motion abnormality, and a diastolic dysfunction of relaxation abnormality. The patient underwent coronary computed tomographic (CT) angiography. It demonstrated the presence of a single coronary artery with the LCx artery continuing in the course of the RCA and minimal possibility of chronic total occlusion (CTO) of the RCA ostium with a collateral supply from the LCx artery (Fig. 1). It also showed 60% diameter stenosis in the distal LCx artery (Fig. 1).

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, Korea.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

To the Editor, Congenital coronary artery anomalies are infrequently seen during coronary angiographic study, reportedly occurring in 0.64% to 1.3% of patients... A resting electrocardiogram demonstrated a convex-shaped ST-segment elevation in the precordial lead without reciprocal change... Laboratory findings including cardiac markers showed no abnormalities... To decide the functional significance of the stenosis in the distal LCx artery, we performed an FFR study with a pressure wire and found that there was no critical functional stenosis (FFR, 0.9) (Fig. 2D)... A single coronary artery is an extremely rare congenital anomaly characterized by a single coronary artery ostium from an aortic sinus, and is seen in only 0.024% to 0.066% of patients who undergo conventional coronary angiography... A single coronary artery is usually asymptomatic and has a benign course, and these patients have a normal life expectancy... FFR is a physiologic parameter that can be readily measured during the invasive procedure and can evaluate the functional significance of coronary stenosis... In particular, FFR plays an important role when making a decision for percutaneous coronary intervention (PCI) of angiographically moderate stenosis and assessing accurately the functional consequences of a given coronary stenosis with unclear hemodynamic significance... In addition, the clinical outcome of patients in whom PCI is deferred because FFR indicated no hemodynamically significant stenosis was very favorable... With FFR, we could make a decision for deferred PCI and choose medical treatment, even though coronary CT angiography and coronary angiography showed moderate stenosis in the LCx artery... In conclusion, FFR could successfully evaluate the functional significance of a moderate stenotic lesion in a single coronary artery where the RCA originated from the terminal portion of the LCx artery.

Show MeSH
Related in: MedlinePlus