Left atrial appendage (LAA) thrombosis is an important cause of cardiogenic cerebral thromboembolism. Apixaban is a member of the class of novel oral anticoagulants (NOAC) and is superior to warfarin in preventing stroke or systemic embolism, causes less bleeding, and results in lower mortality in patients with atrial fibrillation. There are few reports of resolution of LAA thrombus with other NOAC. We present a 72-year-old male patient with persistent atrial fibrillation associated with left atrial thrombus. Sixteen days of apixaban treatment showed complete thrombus resolution. In this study, soluble fibrin and D-dimer levels decreased without prolongation of international normalized ratio (INR) and activated partial thromboplastin time (APTT).
Paroxysmal AF patients have high positive rates of drug-provoked coronary artery spasm. Patients with paroxysmal AF may coincidentally exhibit coronary artery spasm.
Cardiac angiography showed that there was a relationship between the anatomical right ventricular pacing site and paced QRS duration. Cardiac angiography can help determine the areas that produce shorter paced QRS duration.
A 77-year-old woman was admitted to our hospital for evaluation of ischemic heart disease. She underwent two coronary artery bypass graft (CABG) at ages 60 and 67. With the first CABG in 1985, saphenous vein grafts (SVGs) were anastomosed to the left anterior descending (LAD), the obtuse marginal, and the posterior descending arteries (PD). She was asymptomatic until 1992 when she underwent coronary angiography for recurrent chest pain. The angiographic study demonstrated a tight stenosis of the SVG anastomosed to the LAD. The other two SVGs anastomosed to the obtuse marginal and the PD were occluded. She underwent subsequent CABG with three new bypass grafts a left internal thoracic artery graft (LITA) to LAD, a SVG to the obtuse marginal artery, and the gastroepiploic artery (GEA) to the PD. However postoperative angiography showed that the LITA and GEA were occluded. She therefore underwent percutaneous transluminal coronary angioplasty (PTCA) to the first SVG graft anastomosed to the LAD. The angiographic study status post PTCA demonstrated an intact SVG graft. The patient did well and had no chest pain for almost 10 years; she had been clinically man-
Saphenous Vein Graft Aneurysm Late After Coronary Artery
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