Coronary hemodynamic and myocardial metabolic responses before and after perhexiline administration were studied in 21 patients with coronary heart disease during pacing-induced angina pectoris. Perhexiline increased the threshold to tachycardia-induced angina pectoris in 16 of the 21 patients (HR 123 ± 3 to 134 3 beats/min, P < 0.01). Anaerobic myocardial lactate extraction was reduced by -6.1 ± 6.3 to 10.7 4% after perhexiline, although lactate extraction declined in four patients and ST segment depression was not significantly changed. Myocardial oxygen extraction was enhanced, 64 2 to 69 2% (P < 0.05). Coronary flow as reflected by coronary sinus blood flow was not altered (165 24 to 173 26 cc/min) as left ventricular oxygen utilization was increased (18.9 ± 4 to 20.9 ± 4 ml/min, P < 0.05). These findings are interpreted to indicate decreased myocardial ischemia in certain patients on perhexiline.
A patient presenting with signs and symptoms suggesting myocardial ischemia was found to have anomalous origin of his right coronary artery from the left aortic sinus of valsalva associated with a bicuspid aortic valve. Abnormal left ventricular function with anaerobic myocardial metabolism was documented in the absence of significant coronary artery disease or aortic obstruction. The possible relationship of these findings to the coronary artery anomaly and bicuspid aortic valve is considered. The necessity of identification of the origin of the coronary arteries is re-emphasized in the evaluation of patients with bicuspid aortic valves coming to cardiac catheterization. Anomalous origin of a coronary artery is a rare occurrence. The association of this anomaly with a bicuspid aortic valve has not been emphasized and the possible clinical consequences of this combination of malformations have not been described. We recently evaluated a patient with anomalous origin of right coronary artery from the left coronary ostium and a bicuspid aortic valve. A description of these findings follows.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.