Percutaneous Transluminal Coronary Angioplasty for Culprit Lesions in Patients with Post Myocardial Infarction Angina Based on Dextrocardia and Anomalous Coronary Arteries

Abstract

Four cases of successful coronary angioplasty for anomalous coronary arteries, including dextrocardia associated with three-vessel disease, single left coronary artery with proximal left anterior descending lesion, anomalous right coronary artery (RCA) from adjacent left coronary sinus of Valsalva associated with proximal RCA lesion, and anomalous left circumflex angulated lesion bifurcated from the RCA, were encountered. Four cases with 8 target lesions who had a mean age of 63.5 +/- 11.5 years old are presented. All the targets lesions were completely dilated through balloon angioplasty, including use of a newly developed support device for cases with large jeopardized myocardium. The factors for complete revascularization were appropriate selection of catheters and originality and ingenuity of procedural technique based on the anatomic characteristics.

Origin and course of the coronary arteries in normal mice and in iv/iv mice

“…This coincides with the unexpectedly high incidence of anomalies reported here. We have not found any case of coronary arteries arising from the noncoronary (nonfacing) aortic sinus, or from one of the pulmonary sinuses, as has been reported in humans (Yabe & Tsukahara, 1995 ;Shanoudy & Russell, 1996). The possibility that we have missed such an abnormal origin is unlikely.…”

“…: j34 942 201924 ; fax : j34 942 201903 ; e-mail : icardojm!unican.es 1999). Coronary anomalies, however, occur when the heart is abnormally located, or in the presence of abnormal venoatrial connections, although the number of cases reported is very small if there are no associated intracardiac malformations (Topaz et al 1992 ;Yabe & Tsukahara, 1995 ;Shanoudy & Russell, 1996 ;Turchin et al 2000). The rarity of these situations has precluded the analysis of large samples.…”

“…The literature contain many reports on the incidence of coronary anomalies, and similar anomalies to those reported here have often been described (Baltaxe & Wixson, 1977 ;Roberts, 1986 ;Yamanaka & Hobbs, 1990 ;Topaz et al 1992 ;Li et al 2000). The incidence of anomalies is very high in the so-termed heterotaxia syndrome (see, for a recent paper, Uemura et al 1999), although the reports are very scarce if no heart malformations are associated (Wester et al 1994 ;Yip et al 1994 ;Yabe & Tsukahara, 1995 ;Shanoudy & Russell, 1996 ;Turchin et al 2000). Despite this, data analyses indicate that the coronary anomalies may have a higher than expected frequency (Turchin et al 2000).…”

Coronary angioplasty via the radial approach in an individual with dextrocardia

“…Others have employed an AL1 guide [1,2]. From the radial approach we found that Judkins catheters were not useful and that an extra backup guide was most satisfactory.…”

“…Some authors have chosen to use horizontal (right to left) image reversal during image processing so that the images obtained are effectively normalised [1]. We simply used equivalent right-sided views to produce the usual left-sided images and vice versa.…”