Project description:We present a case of valve-sparing root reimplantation in a patient with severe aortic regurgitation, in the setting of a bicuspid aortic valve with an aberrant circumflex coronary artery arising from the right coronary artery, thus rendering standard dissection of the aortic root during a David procedure challenging and risky.
Project description:The role of cardiac computed tomography in the evaluation of patients for transcatheter aortic valve implantation is well-established. However, its role in the evaluation of anomalous vessels in the pre-procedure planning, intra-procedural fusion imaging and post-procedure assessment of vessel patency is not yet defined. This case report illustrates the utility of cardiac CT throughout the management of complex structural interventions. Here, we describe an anomalous left coronary artery where the course of the anomalous vessel and its proximity to the aortic valve annulus is defined allowing the selection of the most appropriate balloon expandable valve with a planned deployment. Upon follow up, patency of this anomalous vessel is ascertained using CT as well as the transcatheter valve function and leaflet thickening.
Project description:BackgroundMitral valve (MV) repair or replacement surgery is indicated for a variety of conditions. Although uncommon, damage to the left circumflex (LCx) coronary artery, which courses in close proximity to the MV annulus, is a devastating complication.Case summaryThis report describes the case of a 63-year-old woman following re-operative MV replacement. Shortly after being transferred to the surgical intensive care unit after MV replacement, her EKG was notable for persistent inferolateral ST-segment elevations and reciprocal ST-segment depressions. Emergency transthoracic echocardiogram revealed a reduced left ventricular ejection fraction of 35-40% and mid to distal lateral wall motion hypokinesis. She was emergently taken to the cardiac catheterization laboratory where coronary angiography demonstrated complete occlusion of her mid LCx artery. She underwent urgent percutaneous coronary intervention of the lesion and was started on dual antiplatelet treatment, anticoagulation for comorbid atrial fibrillation, as well as guideline directed medical therapy with improvement in her EKG changes and cardiac function.ConclusionPrompt diagnosis and recognition of LCx injury is crucial. Management involves immediate percutaneous recanalization or surgical coronary bypass grafting.
Project description:A novel coronary anatomy in the form of anomalous left anterior descending coronary artery from pulmonary artery with a retroaortic left circumflex arising from the right coronary artery is presented. This unreported anatomy was discovered in a 7-month-old girl with failure to thrive. (Level of Difficulty: Intermediate.).
Project description:Transcatheter aortic valve replacement (TAVR) is widely performed in patients with severe aortic stenosis (AS), having a high surgical risk. However, reports of TAVR performed in patients with anomalous coronary arteries are rare. In existing literature, several complications including coronary obstruction are reported. In this study, we report a 77-year-old female patient with severe AS and anomalous origin of the left coronary artery from the right coronary sinus, who successfully underwent TAVR. <Learning objective: During transcatheter aortic valve replacement in patients with anomalous coronary arteries, special attention might be given to the topographical location of the coronary artery from the aortic root and the implanted valve for preventing a coronary obstruction.>.