In order to study the effects of eicosapentaenoic acid (Maxepa), Maxepa placebo and aspirin/dipyridamole combination on the clinical course and restenosis rate of atherosclerotic lesions after percutaneous transluminal coronary angioplasty 79 men and 29 women were randomly divided into three treatment groups and restudied angiographically within one year of the procedure. Angina recurred less in the Maxepa group than in the other groups, although not statistically so. Restenosis rate was significantly reduced in the Maxepa group (11%) compared to the placebo group (30%) but, while less, was not significantly lower than in the aspirin/dipyridamole group (17%). Maxepa treatment appears to reduce restenosis rate of coronary artery lesions after percutaneous transluminal coronary angioplasty and may be an acceptable and equally effective alternative therapy to aspirin/dipyridamole.
suMMARY Left main stem coronary artery dissection is a rare cause of sudden death. This occurred in a previously asymptomatic 42-year-old white woman; clinical, arteriographic, and necropsy findings are described. Extrathoracic total body perfusion with isolated catheter perfusion of the dissected coronary artery using cold cardioplegic solution may be effective preoperative treatment.Spontaneous dissection of the coronary arteries is a rare cause of death occurring predominantly in previously asymptomatic young women, often in the puerperium.1 Cases of coronary artery dissection (both acute and delayed) have been recognised in association with coronary angiography; these patients probably have the best chance of survival as the condition can be readily recognised in the catheter laboratory or shortly after the investigation.2 It has been described as a complication of cardiac operations,3 and related by these authors to postoperative increases of systolic blood pressure or trauma to the coronary orifices by prosthetic valve cages or coronary cannulae. Most cases of coronary artery dissection involve the anterior descending branch of the left coronary artery. Left main stem dissection has been previously described in two cases only.4 5 Case report A white woman aged 42 had had four uneventful pregnancies, the last one eight years previously, and gave a history of migraine which had been treated with low dose clonidine (Dixarit).* She had no recent treatment, was a mild smoker (three a day), and was not taking oral contraceptives. Her husband, a medical practitioner, had noted in the past random blood pressures of90 to 110/65 to 70 mmHg.At 9.30 am after a leisurely breakfast, she complained of a tight feeling in the chest which rapidly escalated into a severe, crushing retrosternal pain. She rational, and anxious. Blood pressure was 90/60 mmHg. An electrocardiogram taken at admission showed an intraventricular conduction defect. On transfer to the medical intensive care unit she developed bradycardia, which responded to atropine, followed by sinus tachycardia. Ventricular fibrillation occurred which was unresponsive to countershock. Cardiac massage was initiated with the Automatic Resuscitator,t maintaining cardiac output, consciousness, and urinary output. Diagnoses considered were pulmonary embolus, myocardial infarction, and aortic dissection.She was transferred to the catheter laboratory for right and left heart studies while still being mechanically massaged. A systolic pressure of 60 mmHg was maintained throughout all chambers by the mechanical resuscitator. Pulmonary angiography showed normal pulmonary arteries. For left coronary arteriography resuscitation was temporarily stopped, so that during this time there was no effective cardiac output. After injection (5 s) massage was resumed. Fig. 1 shows the contrast in the left main stem and shows the dissection spreading to the origins of the circumflex and anterior descending branches. No pressure was recorded with the catheter passed through the coronary ...
A case of a 12-year-old boy who had double false aneurysms of the right ventricle after incomplete closed pulmonary valvotomy six years earlier is presented. The aneurysms were successfully treated surgically, and the aetiology is discussed.False ventricular aneurysms are a rare and poten-reduced exercise tolerance. In May 1973 a routine chest tially fatal complication of cardiac surgery. They are radiograph disclosed a widened mediastinum and a large less common than true aneurysms (Hurst, Fine, round Edwards, I972;Rosenthal et al., 1972). Both types pulse was 2 cm above the sternoclavicular joint, with a of aneurysms are more frequent sequelae of opera-prominent ca' wave. There were distinct visible pulsations tions on the left ventricle (Littler et al., 197I).at the second and third left intercostal spaces. A grade This report describes what we believe to be a 4/6 ejection systolic murmur was heard at the pulmonary unique case of a patient who, after a closed pul-area, with grade 3/4 pulmonary diastolic murmur. There monary valvotomy, developed a false right ventric-were no signs of heart failure, and the previous thoracular aneurysm. This aneurysm, in turn, had rup-otomy was well healed, with a keloid scar. Routine labtured into the left pleural cavity, resulting in a oratory investigations were normal. The chest radiosecond false chamber. The patient survived this graph showed a large right ventricle and slightly oligseventond surgicalse chambection ohe lesion followed aemic lung fields. A large rounded shadow was superevent and surgical correction of the lesion followed imposed on the main pulmonary artery and extended, successfully.just above it, into the upper left lung field. The lateral view showed anteroposterior extension of the mass (Fig. I). Case historyThe electrocardiogram showed right axis deviation and right ventricular hypertrophy.A 12-year-old West Indian negro boy was born norCardiac catheterization disclosed a residual gradient mally at full term. His mother had had rubella in of 6o mmHg (8.o kPa) across the pulmonary valve: the first month ofpregnancy, and a heart murmur was dis-MPA pressure 30/I3 mmHg (4.0/I.7 kPa), RV body covered when he was 3 months old. He failed to thrive 90/21 mmHg (120/2.8 kPa), pressure within aneurysm and was prone to upper respiratory tract infection. In 89/i5 mmHg (ii.8/2.o kPa). I967, at the age of 5 years, the diagnosis of pulmonaryThe cineangiocardiogram of the right ventricle showed stenosis was made, and a transventricular pulmonary a centrally placed mediastinal aneurysm above and valvotomy was performed through a left thoracotomy. anterior to the heart, which filled by a jet from the right Apart from transient early postoperative pulmonary col-ventricular infundibulum. This mediastinal sac, in turn, lapse and infection he maintained a gradual progressive communicated with and filled a posterolaterally placed improvement. Three years later he experienced slightly sac in the left pleura.
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