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Congenital coronary artery anomalies silent until geriatric age: non-invasive assessment, angiography tips, and treatment.

Rigatelli G, Dell'Avvocata F, Van Tan N, Daggubati R, Nanijundappa A - J Geriatr Cardiol (2015)

Bottom Line: Finally, the knowledge of the particular endovascular techniques and material is of paramount importance for achieving technical and clinical success.CAAs represent a complex issue, which rarely involve the cardiovascular professional at different levels.A timely practical knowledge of the main issues regarding CAAs is important in the management of such entities.

View Article: PubMed Central - PubMed

Affiliation: Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy.

ABSTRACT
Coronary artery anomalies (CAAs) may be discovered more often as incidental findings during the normal diagnostic process for other cardiac diseases or less frequently on the basis of manifestations of myocardial ischemia. The cardiovascular professional may be involved in their angiographic diagnosis, functional assessment and eventual endovascular treatment. A complete angiographic definition is mandatory in order to understand the functional effects and plan any intervention in CAAs: computed tomography and magnetic resonance imaging are useful non-invasive tools to detect three-dimensional morphology of the anomalies and its relationships with contiguous cardiac structures, whereas coronary arteriography remains the gold standard for a definitive anatomic picture. A practical idea of the possible functional significance is mandatory for deciding how to manage CAAs: non-invasive stress tests and in particular the invasive pharmacological stress tests with or without intravascular ultrasound monitoring can assess correctly the functional significance of the most CAAs. Finally, the knowledge of the particular endovascular techniques and material is of paramount importance for achieving technical and clinical success. CAAs represent a complex issue, which rarely involve the cardiovascular professional at different levels. A timely practical knowledge of the main issues regarding CAAs is important in the management of such entities.

No MeSH data available.


Related in: MedlinePlus

Sub-selective angiography from the radial approach of an ectopic origin of the left coronary artery from the right sinus in a 69-year old male.
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jgc-12-01-066-g002: Sub-selective angiography from the radial approach of an ectopic origin of the left coronary artery from the right sinus in a 69-year old male.

Mentions: The left coronary artery (LCA) originates from the opposite sinus, there are four pathways: the interarterial course (rare), septal course (common), the retroaortic and the anterior courses. The course of an anomalous coronary artery is confirmed by the 30° right anterior oblique view. In this projection, a dot represents the artery seen on end. The interarterial course is diagnosed by the position of the “dot” anterior to the aorta; the retroaortic, by the “dot” behind the aorta; the septal is recognized by the fish hook picture in the right anterior oblique view, because the LM goes down to the septum then comes up to the epicardium, like a fish hook (Figure 2 ). Then the LCx would curve backward and from the “eye” with the LCx as the upper border.[11] In the anterior (pathway) the LM is in front of the pulmonary artery. This pathway is recognized by the “eye” with the LM as the upper border and the LCx as the inferior border. Selective coronary angiography with previous Swan-Ganz catheter placement in the main pulmonary artery does not really help to recognize interarterial passage. When the RCA arises from the left sinus or from the proximal LM (Figure 3), in the right anterior oblique view, the RCA will be seen head-on, as a dot anterior to the aorta. Eventual intramural passage of the anomalous vessel within the aortic wall is visualized in cranial left anterior oblique for RCA and in cranial right anterior oblique for LCA by left Judkins catheter or right Amplatz catheter, respectively.


Congenital coronary artery anomalies silent until geriatric age: non-invasive assessment, angiography tips, and treatment.

Rigatelli G, Dell'Avvocata F, Van Tan N, Daggubati R, Nanijundappa A - J Geriatr Cardiol (2015)

Sub-selective angiography from the radial approach of an ectopic origin of the left coronary artery from the right sinus in a 69-year old male.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4308460&req=5

jgc-12-01-066-g002: Sub-selective angiography from the radial approach of an ectopic origin of the left coronary artery from the right sinus in a 69-year old male.
Mentions: The left coronary artery (LCA) originates from the opposite sinus, there are four pathways: the interarterial course (rare), septal course (common), the retroaortic and the anterior courses. The course of an anomalous coronary artery is confirmed by the 30° right anterior oblique view. In this projection, a dot represents the artery seen on end. The interarterial course is diagnosed by the position of the “dot” anterior to the aorta; the retroaortic, by the “dot” behind the aorta; the septal is recognized by the fish hook picture in the right anterior oblique view, because the LM goes down to the septum then comes up to the epicardium, like a fish hook (Figure 2 ). Then the LCx would curve backward and from the “eye” with the LCx as the upper border.[11] In the anterior (pathway) the LM is in front of the pulmonary artery. This pathway is recognized by the “eye” with the LM as the upper border and the LCx as the inferior border. Selective coronary angiography with previous Swan-Ganz catheter placement in the main pulmonary artery does not really help to recognize interarterial passage. When the RCA arises from the left sinus or from the proximal LM (Figure 3), in the right anterior oblique view, the RCA will be seen head-on, as a dot anterior to the aorta. Eventual intramural passage of the anomalous vessel within the aortic wall is visualized in cranial left anterior oblique for RCA and in cranial right anterior oblique for LCA by left Judkins catheter or right Amplatz catheter, respectively.

Bottom Line: Finally, the knowledge of the particular endovascular techniques and material is of paramount importance for achieving technical and clinical success.CAAs represent a complex issue, which rarely involve the cardiovascular professional at different levels.A timely practical knowledge of the main issues regarding CAAs is important in the management of such entities.

View Article: PubMed Central - PubMed

Affiliation: Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy.

ABSTRACT
Coronary artery anomalies (CAAs) may be discovered more often as incidental findings during the normal diagnostic process for other cardiac diseases or less frequently on the basis of manifestations of myocardial ischemia. The cardiovascular professional may be involved in their angiographic diagnosis, functional assessment and eventual endovascular treatment. A complete angiographic definition is mandatory in order to understand the functional effects and plan any intervention in CAAs: computed tomography and magnetic resonance imaging are useful non-invasive tools to detect three-dimensional morphology of the anomalies and its relationships with contiguous cardiac structures, whereas coronary arteriography remains the gold standard for a definitive anatomic picture. A practical idea of the possible functional significance is mandatory for deciding how to manage CAAs: non-invasive stress tests and in particular the invasive pharmacological stress tests with or without intravascular ultrasound monitoring can assess correctly the functional significance of the most CAAs. Finally, the knowledge of the particular endovascular techniques and material is of paramount importance for achieving technical and clinical success. CAAs represent a complex issue, which rarely involve the cardiovascular professional at different levels. A timely practical knowledge of the main issues regarding CAAs is important in the management of such entities.

No MeSH data available.


Related in: MedlinePlus