Acute Myocardial Infarction After Surgical Closure of Coronary Artery Fistula : Importance of Anticoagulant Therapy
Ontology highlight
ABSTRACT:
SUBMITTER: Meng L
PROVIDER: S-EPMC9207945 | biostudies-literature | 2022 Jun
REPOSITORIES: biostudies-literature
Similar Datasets
Project description:A 56-year-old man presented to the emergency department with chest pain. The diagnosis of acute myocardial infarction caused by a left circumflex artery occlusion was made. After conservative treatment, a fistula between the circumflex artery and the left ventricle, and the evolution of the pseudoaneurysm, were noted. (Level of Difficulty: Advanced.).
| S-EPMC8853947 | biostudies-literature
Project description:Two years previously, a 73-year-old man with mitral regurgitation underwent mitral annuloplasty and left atrial appendage (LAA) exclusion by suturing the orifice from the endocardium. However, the mitral regurgitation became exacerbated, and the left atrium enlarged rapidly over a 6-month period. Computed tomography showed a heterogenic mass in the LAA, and coronary angiography revealed a coronary artery-LAA fistula. Reoperation revealed a thrombus filling the appendage and two small orifices of the coronary artery-LAA fistula located in the endocardium of the appendage. We excised the LAA and closed these fistula orifices concomitant with mitral valve replacement.
| S-EPMC4360659 | biostudies-other
Project description:Acquired coronary artery fistula complicated with a pseudo-false aneurysm after percutaneous coronary intervention for myocardial infarction is quite rare. In this clinical vignette, we describe the case of a 79-year-old man who was diagnosed by multimodality imaging, especially transthoracic echocardiography, and is doing well after left ventricle reconstruction. (Level of Difficulty: Intermediate.) Graphical abstract
| S-EPMC10157108 | biostudies-literature
Project description:Coronary arteriovenous fistulae are a rare but potentially curable cause of ischaemic heart disease and should be considered as a differential diagnosis especially in patients lacking classical risk factors for coronary artery disease. We discuss one such case of cardiac ischaemia resulting from a coronary arteriovenous fistula. While there are sporadic case reports of similar patients in medical literature, our patient is the first reported case of ST-elevation myocardial infarction secondary to the fistulous connection.
| S-EPMC4544331 | biostudies-other
Project description:Coronary artery disease (CAD) is the leading cause of mortality worldwide. We aimed to compare expression of miRNA in the affected artery of acute myocardial infarction (ST-elevation myocardial infarction) male patients versus healthy individuals (control). Blood samples were collected during coronary catheterization from proximal culprit coronary arteries aimed for the interventions or from a random artery in control samples. RNA isolated from serum was used for miRNA high throughput sequencing.
2023-04-23 | GSE230165 | GEO
Project description:BackgroundA coronary artery aneurysm (CAA) is an abnormal dilation of a coronary artery segment often accompanied by coronary artery fistula (CAF), leading to communication between a coronary artery and a cardiac chamber or a part of the coronary venous system. Both CAAs and CAFs can present with symptoms and signs of myocardial ischemia and infarction.Case presentationWe describe the case of a 46-year-old woman with non-ST-elevation myocardial infarction (NSTEMI) caused by a "giant" CAA. Various imaging modalities revealed a thrombus-containing aneurysm located at the right-posterior cardiac border, with established arteriovenous communication with the distal part of left circumflex artery (LCx). After initial treatment with dual antiplatelet therapy, a relapse of pain was reported along with a new increase in troponin levels, electrocardiographic abnormalities, reduced left ventricular ejection fraction (LVEF) and thrombus enlargement. Surgical excision of the aneurysm was favored, revealing its true size of 6 cm in diameter. Τhe aneurysm was excised without complications. The patient remained asymptomatic during follow-up.ConclusionsManagement of rare entities such as "giant" CAAs and CAFs can be challenging. Cases such as this can serve as precedents to facilitate treatment plans and develop consistent recommendations, emphasizing the importance of personalized strategies for future patients.
| S-EPMC10986014 | biostudies-literature
Project description:Background Though rare, myocardial infarction secondary to coronary artery dissection is a life-threatening event. In reproductive age women, it commonly occurs during pregnancy or the postpartum period. Case We present a case of pregnancy-related acute myocardial infarction due to spontaneous coronary artery dissection in a 37-year-old woman who presented to the emergency room with shortness of breath and sudden onset of retrosternal chest pain 8 days after delivery of premature twins. Coronary artery catheterization showed 75 to 90% stenosis in the left main coronary artery (LMCA), extending into the proximal and mid left anterior descending (LAD) branch. The LMCA appearance in the heart catheterization was consistent with vasospasm, but it was not responsive to medical management. Subsequently, she underwent a second coronary artery catheterization and was found to have dissection requiring emergent coronary artery bypass graft × 3 in the LMCA, circumflex, and LAD that was followed by an uneventful recovery. Conclusion Early diagnosis and management of myocardial infarction due to coronary artery dissection in the peripartum period is crucial. This condition should be suspected in young reproductive age women, even in the setting of minimal risk factors. Angiography is required for diagnosis. Management should be individualized as it may include both invasive and noninvasive measures.
| S-EPMC4603869 | biostudies-other
Project description:IntroductionAcute myocardial infarction (AMI) is a major global health concern. However, the optimum timing of coronary artery bypass grafting (CABG) in AMI patients remains controversial. This study investigated the optimal timing of CABG and its impact on postoperative outcomes. We hypothesized that determining the optimal timing of CABG could positively impact postoperative outcomes.MethodsWe conducted a nationwide retrospective analysis of the National Health Insurance Service of Korea database, focusing on 1 705 843 adult AMI patients diagnosed between 2007 and 2018 who underwent CABG within 1 year of diagnosis. Patients were categorized based on CABG timing. Primary endpoints included cohort identification and the time interval from AMI diagnosis to CABG. Secondary endpoints encompassed major adverse cardiac and cerebrovascular events (MACCEs) and the impact of postoperative medications.ResultsOf the patients, 20 172 underwent CABG. Surgery within 24 h of AMI diagnosis demonstrated the most favorable outcomes, reducing cardiac death, myocardial infarction recurrence, and target vessel revascularization. Delayed CABG within 3 days also outperformed surgery within 1-2 days post-AMI. Additionally, postoperative aspirin use was associated with improved MACCE outcomes.ConclusionCABG within 24 h of AMI diagnosis was associated with significantly minimized myocardial injury, emphasizing the critical role of rapid revascularization. Delayed CABG within 3 days related to better outcomes compared with that of surgery within 1-2 days. These findings provide evidence-based recommendations for optimizing CABG timing in AMI patients, consequentially reducing morbidity and mortality.
| S-EPMC11322592 | biostudies-literature
Project description:Left ventricle (LV) pseudoaneurysm is a rare disorder post-acute myocardial infarction (AMI). Resection or closure of the pseudoaneurysm by surgery is recommended due to the high propensity of pseudoaneurysm rupture while surgery has also high risks. Conservative therapy could be acceptable in small pseudoaneurysms or patients with high surgical risks. Nevertheless, the risk evaluation and grasp of indication are not clear. This case reported an acute cyst-like LV pseudoaneurysm formation post-AMI-induced myocardial free wall rupture (MFWR), and the patient recovered with spontaneous closure of the fissure and shrinkage of the LV pseudoaneurysm through non-surgical therapy. Based on the observations in the echocardiogram, we proposed that intermittent closing of the fissure and interruption of the blood flow between the LV and the pseudoaneurysm due to LV contraction alleviated stress change on the pseudoaneurysm. The narrow fissure, small pseudoaneurysm, and intermittently interrupted blood flow that benefit fissure healing and pseudoaneurysm stabilization could indicate the prognosis of this patient. Drugs like β-blocker that decreased the stress on the pseudoaneurysm also led to the risk reduction of pseudoaneurysm rupture. To our knowledge, this is the first case that reports a spontaneous closure of LV pseudoaneurysm. The size of the fissure and the pseudoaneurysm, as well as the corresponding hemodynamic state, could be valuable to evaluate the risk and prognosis of the pseudoaneurysm. Optimized medical management was also helpful to pseudoaneurysm stabilization.
| S-EPMC9530630 | biostudies-literature
Project description:BackgroundWomen have been underrepresented in the literature; the effects of female sex on outcomes in patients with acute myocardial infarction (AMI) remain unclear.ObjectivesThis study compares the real-world outcomes of women and men with AMI who have undergone revascularization via percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG).MethodsThis is a retrospective cohort study utilizing data from the Taiwan National Health Insurance database. We identified patients who were admitted for AMI and who underwent coronary revascularization during the index admission period between January 1, 2001, and December 31, 2013. Patients were then categorized based on the treatment received into PCI and CABG groups. In-hospital and long-term outcomes were compared between women and men in each group. Interaction tests were then performed to determine whether the differences between sexes were modified by the mode of revascularization. Analyses were repeated after propensity score matching between women and men in each group to minimize possible confounders. We also conducted subgroup analyses, stratifying by the presence of diabetes mellitus, congestive heart failure, and chronic kidney disease.ResultsWe enrolled 67,534 patients who met the inclusion criteria in the analysis; 60,207 patients had undergone PCI (13,514 female and 46,693 male), while 7327 patients had received CABG (1762 female and 5565 male). Prior to matching, enrolled female patients were older on average, with more comorbidities. In-hospital and long-term outcomes were worse in women, particularly in the PCI group. After matching, the incidence of hospitalization for heart failure (HHF) was higher in women (10.4% vs 8.0%, OR 1.32, 95% CI 1.22-1.43), with fewer repeat revascularizations (28.1% vs 32.4%, OR 0.84, 95% CI 0.81-0.88). Both observations were more pronounced in the PCI group (HHF: P for interaction = 0.0496; repeat revascularization: P for interaction = 0.021).ConclusionsWomen presenting with AMI exhibited worse in-hospital and long-term outcomes than men, especially among women who received PCI as the initial mode of revascularization. Women who underwent PCI were more likely to be admitted for heart failure during follow-up. Possible socioeconomic inequalities or a distinct pathobiology of cardiac ischemia between sexes may underlie these results; thus, further investigation is needed.
| S-EPMC9044854 | biostudies-literature