Dissection – ABC CARDIOL

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Case Report

Spontaneous Coronary Artery Dissection and Diagnosis by Computed Tomography Angiography: a Case Report

Mathias Silvestre de Brida et al. Georgia Pergher Postingher Fábio Vieira Caovilla Juarez Neuhaus Barbisan

Introduction

Spontaneous coronary artery dissection (SCAD), defined as separation of the layers of the coronary wall unrelated to trauma, iatrogenesis, or atherosclerosis, often occurs in young women without cardiovascular risk factors. First described almost a century ago, it was poorly understood for some time, known only to be associated with the peripartum and pregnancy periods. SCAD is a rare cause of acute coronary syndrome (ACS), and despite technological advances in invasive or non-invasive imaging tests increasing our understanding of its pathophysiology and treatment, it remains underdiagnosed. This report describes the case of an ACS patient without obstructive lesions on coronary angiography in which coronary computed tomography angiography (CCTA) was an indispensable tool in the diagnosis of SCAD with an unusual location, highlighting its growing importance based on the current scientific literature.

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IJCS

Case Report

Beyond Atherothrombotic Disease in Acute Coronary Syndrome

Mayra Alejandra Mora et al. Manuela Molano-Perez Cristian Orlando Becerra-Gonzalez Kenny Buitrago-Toro … Silvana Jimenez-Salazar Carlos Ortiz

Abstract

Half of the global population over 20 years of age will be affected by cardiovascular disease. Cardiovascular events in young people is challenging. Spontaneous coronary artery dissection is a non-traumatic and non-iatrogenic separation of the coronary arterial wall and is an uncommon and underdiagnosed cause of acute myocardial infarction predominately found in young women. Medical management has been more widely accepted, with percutaneous and surgery treatment reserved for precise indications. Optimal control of individual risk factors is essential in order to avoid recurrences.

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Case Report

Spontaneous Coronary Artery Dissection – Case Report and Literature Review

Elana Couto de Alencar Daniel et al. João Luiz de Alencar Araripe Falcão

Introduction

We report three cases of spontaneous coronary artery dissection (SCAD), with literature review and discussion of the procedures employed. All of them occurred in women, with the diagnosis being made by coronary angiography and, in one case, confirmed by intravascular ultrasound (IVUS).

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IJCS

Case Report

A Transcatheter Aortic Valve Implantation Without Aortography Guidance Due To Vascular Access Constraints Or Limitations

Oktay Ergene et al. Hamza Duygu Volkan Emren Ugur Kocabas Levent Cerit

Introduction

Aortic valve replacement (AVR) is an established treatment modality in patients with severe symptomatic aortic stenosis (AS).^, Given the increased mortality and morbidity of AVR for the high-risk patients and the poor long-term results of balloon aortic valvuloplasty, transcatheter aortic valve implantation (TAVI) is increasingly accepted treatment option who are not candidates for AVR. We describe here a case of succesfully implanted Edwards SAPIEN XT transcatheter heart valve without aortography guidance due to multiple arterial access problems and complicated by iatrogenic De Bakey type III aortic dissection and severe paravalvular leak.

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ABC

Case Report

Spontaneous Coronary Artery Dissection in Acute Coronary Syndrome: Report of a Series of Cases with 17 Patients

Ana Rita Godinho et al. Mariana Vasconcelos Vitor Araújo Maria Júlia Maciel

Introduction

Spontaneous Coronary Artery Dissection (SCAD) has prevalence of 0.2 to 1.1% of the total angiograms performed for Acute Coronary Syndrome (ACS)^, and mostly affects young women. The etiology is not fully known,^, but the term “spontaneous” excludes all dissections associated with interventions or trauma. Treatment varies from the conservative approach to revascularization, with a favorable long-term prognosis.

This study aimed to assess the characteristics, the clinical presentation, therapeutic approach and follow-up of cases of SCAD with ACS presentation during a period of 7 years.

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Case Report

Acute coronary artery dissection after aortic valve replacement

Fernando de Paula Machado et al. Roney Orismar Sampaio Fernanda Lopez Mazzucato Flávio Tarasoutchi … Guilherme Sobreira Spina Max Grinberg

Late aortic dissection can occur after aortic valve replacement surgery, but rarely in the first postoperative month. Coronary artery dissection is rare and usually occurs after coronary angiography. We report a rare case of coronary artery dissection followed by myocardial infarction in the immediate postoperative period of a successful aortic valve replacement with a good postoperative evolution.

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Case Report

Anatomy of a dextrocardia case with situs solitus

Fabíola Sawaguchi Faig-Leite et al. Horácio Faig-Leite

We present a rare case of dextrocardia in the corpse of a female child, aged approximately one year old, presenting situs solitus. The cases of dextrocardia reported in the literature normally describe multiple associated cardiac malformations. In the present study, it is noteworthy the fact that a complete specular image of the heart and the vessels of the base of the heart was not found. There was no atrioventricular discordance or other intra and extracardiac malformations, which are commonly seen in cases of dextrocardia. A large ductus arteriosus was found, as well as the anomalous position of the right portion of the heart.

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Artigo Original

Clinical meaning of uncomplicated coronary dissections after stent implantation

Alexandre Schaan de Quadros et al. Carlos A. M. Gottschall Rogério Sarmento-Leite Lenise Valler André Bussmann

OBJECTIVE: To assess the influence of uncomplicated coronary dissections in the incidence of target vessel revascularization and cardiovascular events after 1 year. METHODS: Patients treated from June 1996 to December 2000, with data prospectively collected and uncomplicated dissections (G1, n=36), were compared with those patients without dissections (G2, n=871). Data were assessed with SPSS 8.0 statistical software, the outcomes were compared with the Kaplan-Meier curve, and the significance level was assessed using the log-rank test. RESULTS: Clinical features were similar in both groups: G1 had lower mean reference diameters (P<0.0001), a greater number of patients with type C lesions (P=0.01), a lower final lumen diameter at the end of the procedure (P=0.003), and a greater balloon/artery ratio (P<0.0001). In the multivariate analysis, only the reference diameter and the artery/balloon ratio were independently associated with the presence of residual dissections. No statistically significant difference existed in the incidence of revascularization of the target vessel and major cardiovascular events, at 1-year clinical follow-up, between the 2 groups of patients. Predictors of adverse clinical events at 1 year were the reference diameter, lesion extension, and residual stenosis, rather than the presence of residual dissection. CONCLUSION: Uncomplicated residual dissections after coronary stents are associated with narrower vessels and a higher balloon/artery ratio. Residual dissections are not associated with worse outcomes at 1-year clinical follow-up.

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