coronary artery – ABC CARDIOL

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Research Letter

[PARTIAL-RETRACTION] MINOCA Phenotypes – A Challenge for Patient-Specific Management

Abstract

Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a puzzling clinical phenomenon with an unclear prognosis, characterized by evidence of myocardial infarction (MI) with normal or near-normal coronary arteries on angiography¹. Currently, there are no guidelines for management, and many patients are discharged without a determined etiology, often meaning that optimal treatment gets postponed.We report three MINOCA case studies with main pathophysiological cardiac causes, particularly epicardial, microvascular, and non-ischemic, prompting differential management. The patients presented with acute chest pain, troponin raise, and no angiographically significant coronary disease.In this study, we analyzed the etiology, clinical diagnosis, and treatment of MINOCA concerning the relevant literature.MINOCA is considered to be a dynamic working diagnosis, including coronary, myocardial, and non-coronary disorders. Prospective studies and registries are needed to improve patient care and outcome.

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Editorial

My approach to the diagnosis of congenital coronary anomalies by transthoracic echocardiography

Vitor Coimbra Guerra

Why do we need to assess the anatomy of the coronary arteries?

Until a few decades ago, coronary artery anatomy assessment by echocardiogram (ECHO) was considered a difficult secondary task even if analyzed by other cardiovascular imaging modalities, such as angiography by cardiac catheterization. Important changes in this approach in recent years can be explained by three important aspects:1) The origin and initial course of coronary artery anomalies can be a substrate for ischemia and even sudden death in young adults;^,2) Transthoracic echocardiography (TTE) is a non-invasive radiation-free low-cost imaging test in the frontline of cardiac assessments;3) The anatomical and functional assessment of coronary arteries is part of a transthoracic test used to diagnose congenital heart diseases.^,

Which congenital coronary artery anomalies are relevant and should be identified?

[…]

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Original Article

Evaluation of Coronary Circulation after Arterial Switch Operation

Mariana Nicoletti Ferreira Baldo et al. Henrique Simão Trad Tarcisio José da Silva Junior Paulo Henrique Manso

Abstract

Background

Coronary artery evaluation remains after arterial switch operation a clinical challenge.

Objective

This study aims to correlate anatomical changes diagnosed by cardiac computed tomography (CCT) with physiological alterations on clinical evaluation to diagnose coronary obstruction in late ASO patients.

Methods

This study included 61 consecutive patients with mean age of 9.4 years who underwent ASO. The patients were submitted to echocardiography, electrocardiography, cardiopulmonary exercise test, and cardiac computed tomography to evaluate functional capacity and coronary artery anatomy.

Results

Cardiac computed tomography revealed that only 3.3% of the patients had coronary stenosis. These patients were asymptomatic, and no signs of myocardial ischemia were detected by the tests.

Conclusion

The incidence of coronary abnormalities in late ASO patients was 3.3% in our cohort. There is no clear guideline as to why, when, and how these patients should be screened or what to propose when a coronary obstruction is diagnosed in asymptomatic patients.

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Editorial

Coronary Artery Dilation in Children with Febrile Exanthematous Illness without Criteria for Kawasaki Disease -An Enigmatic Disease

Vitor Coimbra Guerra

More than half a century has elapsed since Prof. Tomisaku Kawasaki’s did the first description of a unique disease. He saw the first 4-year-old patient with fever and rash in 1961…. At that time, he described the diagnosis “unknown”. The published paper title was Infantile acute febrile mucocutaneous lymph node syndrome with specific desquamation of the fingers and toes. Clinical observation of 50 cases. From This “unknown diagnosis”, which now we call Kawasaki disease (KD) until the current era, this vasculitis of unknown cause became the leading cause of acquired heart disease among children in United States.

Historically, the presence of coronary abnormalities was not noticed until patients died suddenly of cardiac complications. An angiographic study of 1100 patients showed coronary artery lesions in 24%, with aneurysms in 8% and a number of patients with stenoses and occlusions. As soon as the Coronary arteries became the key structure for risk stratification, treatment and outcome, extensive research and worldwide effort has been done targeting the correct diagnostic. Unfortunately, to make things more challenging, there are forms of “uncomplete KD” which overlaps with other forms of febrile Exanthematous illness in children.

[…]

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Original Article

Morphometric and topographic study of coronary ostia

Jennecy Sales Cavalcanti et al. Natália Corrêa Vieira de Melo Renata Simões de Vasconcelos

OBJECTIVE: To investigate the morphometric and topographic aspects of coronary ostia, correlating them with the aortic leaflets. METHODS: Fifty-one hearts with the great vessels attached were analyzed in this study. The ascending aorta was transversally sectioned 1 cm above the commissures of the aortic leaflets. The right and left coronary ostia were analyzed, as were the distances from these ostia to the bottom of the aortic sinuses and to the commissures of the aortic leaflets. RESULTS: The left coronary ostium was located below the intercommissural line in 42% of cases, above that line in 40% of cases, and at the level of that line in 18% of cases. The mean distance from the left coronary ostium to the bottom of the corresponding sinus was 12.6±2.61 mm. The right coronary ostium was located below the intercommissural line in 60% of cases, above that line in 28% of cases, and at the level of that line in 12% of cases. The mean distance from the right coronary ostium to the bottom of the corresponding aortic sinus was 13.2±2.64 mm. The mean diameters of the left and right coronary ostia were 4.75±0.93 mm and 3.46±0.94 mm, respectively. The mean diameters of the juxtamural portion of the left and right coronary arteries were 3.75±0.79 mm and 2.9±0.73 mm, respectively. In one case, both ostia were located in the left coronary sinus. CONCLUSION: The left coronary ostium may be located either above or below the intercommissural line. The right coronary ostium is predominantly located below the intercommissural line. The coronary ostia have reduced diameters as compared with the juxtamural diameters of their respective coronary arteries.

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Original Article

Effect of arginine vasopressin on the canine epicardial coronary artery: experiments on V1-receptor-mediated production of nitric oxide

Paulo Roberto B. Evora et al. Paul J. Pearson Alfredo J. Rodrigues Fernanda Viaro Hartzell V. Schaff

OBJECTIVE: To determine whether arginine vasopressin releases endothelium-derived nitric oxide (EDNO) from the epicardial coronary artery. METHODS: We studied segments of canine left circumflex coronary arteries suspended in organ chambers to measure isometric force. The coronary artery segments were contracted with prostaglandin F2alpha (2 x 10-6M) and exposed to a unique, strong arginine vasopressin concentration (10-6M) or titrated concentrations (10-9 a 10-5 M). RESULTS: The unique dose of arginine vasopressin concentration (10-6M) induced transient, but significant (p<0.05), relaxation in arterial segments with endothelium, and an increase, not significant, in tension in arteries without endothelium. Endothelium-dependent relaxation to arginine vasopressin was inhibited by Ng-monomethyl-L-arginine (L-NMMA, 10-5M) or N G-nitro-L-arginine (L-NOARG) (10-4M), 2 inhibitors of nitric oxide synthesis from L-arginine. Exogenous L-arginine (10-4M), but not D-arginine (10-4M), reversed the inhibitory effect of L-NMMA on vasopressin-mediated vasorelaxation. Endothelium dependent relaxation to vasopressin was also reversibly inhibited by the vasopressin V1-receptor blocker d(CH2)5Try(Me) arginine vasopressin (10-6M) (n=6, P<0.05). CONCLUSION: Vasopressin acts through V1 endothelial receptors to stimulate nitric oxide release from L-arginine.

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[PARTIAL-RETRACTION] MINOCA Phenotypes – A Challenge for Patient-Specific Management

Abstract

My approach to the diagnosis of congenital coronary anomalies by transthoracic echocardiography

Why do we need to assess the anatomy of the coronary arteries?

Evaluation of Coronary Circulation after Arterial Switch Operation

Abstract

Background

Objective

Methods

Results

Conclusion

Coronary Artery Dilation in Children with Febrile Exanthematous Illness without Criteria for Kawasaki Disease -An Enigmatic Disease

Morphometric and topographic study of coronary ostia

Effect of arginine vasopressin on the canine epicardial coronary artery: experiments on V1-receptor-mediated production of nitric oxide

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