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World Journal of Clinical Cases Sep 2022Quadricuspid aortic valve (QAV) is a very rare congenital cardiac defect with the incidence of 0.0125%-0.033% (< 0.05%) predominantly causing aortic regurgitation. A...
BACKGROUND
Quadricuspid aortic valve (QAV) is a very rare congenital cardiac defect with the incidence of 0.0125%-0.033% (< 0.05%) predominantly causing aortic regurgitation. A certain number of patients (nearly one-half) have abnormal function and often require surgery, commonly in their fifth or sixth decade. QAV usually appears as an isolated anomaly but may also be associated with other cardiac congenital defects. Echocardiography is considered the main diagnostic method although more and more importance is given to computed tomography (CT) and magnetic resonance imaging (MRI) as complementary methods.
CASE SUMMARY
A 60-year-old female patient was referred for transthoracic ultrasound of the heart as part of a routine examination in the treatment of arterial hypertension. She did not have any significant symptoms. QAV was confirmed and there were no elements of valve stenosis with moderate aortic regurgitation. At first, it seemed that in the projection of the presumed left coronary cusp, there were two smaller and equally large cusps along with two larger and normally developed cusps. Cardiac CT imaging was performed to obtain an even more precise valve morphology and it showed that the location of the supernumerary cusp is between the right and left coronary cusp, with visible central malcoaptation of the cusps. Also, coronary computed angiography confirmed the right-type of myocardial bridging at the distal segment of the left anterior descending coronary artery. Significant valve dysfunction often occurs in middle-aged patients and results in surgical treatment, therefore, a 1-year transthoracic echocardiogram control examination and follow-up was recommended to our patient.
CONCLUSION
This case highlights the importance of diagnosing QAV since it leads to progressive valve dysfunction and can be associated with other congenital heart defects which is important to detect, emphasizing the role of cardiac CT and MRI.
PubMed: 36157661
DOI: 10.12998/wjcc.v10.i25.8954 -
Archives of Medical Science : AMS 2023This study aims to compare the safety and efficacy of bivalirudin bridging enoxaparin versus fondaparinux in patients with acute myocardial infarction (AMI) who were...
Efficacy and safety of bivalirudin bridging enoxaparin versus fondaparinux in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention: evidence from a single-center study.
INTRODUCTION
This study aims to compare the safety and efficacy of bivalirudin bridging enoxaparin versus fondaparinux in patients with acute myocardial infarction (AMI) who were undergoing primary percutaneous coronary intervention (PPCI).
METHODS
The study is a prospective, natural, and selective interventional trial based on real-world data for 482 AMI patients.
RESULTS
At the end of the follow-up, the two groups demonstrated similar major adverse cardiovascular and cerebrovascular events (MACCE) and bleeding rates. After propensity score matching (PSM), the fondaparinux group showed greater advantages in reducing MACCE and bleeding events.
CONCLUSIONS
The anticoagulation strategy of bivalirudin bridging fondaparinux seems to be superior to that of bivalirudin bridging enoxaparin in patients with AMI undergoing PPCI.
PubMed: 36817677
DOI: 10.5114/aoms/157287 -
European Heart Journal. Case Reports Feb 2023Physiological assessment of myocardial bridging prevents unnecessary interventions. Non-invasive workup or visual coronary artery compression may underestimate the...
BACKGROUND
Physiological assessment of myocardial bridging prevents unnecessary interventions. Non-invasive workup or visual coronary artery compression may underestimate the underlying ischaemia associated with myocardial bridging in symptomatic patients.
CASE SUMMARY
A 74-year-old male presented to the outpatient clinic with chest pain and shortness of breath on exertion. He underwent coronary artery calcium scan showing an elevated calcium score of 404. On follow-up, he endorsed progressive worsening of symptoms with chest pain and decreased exercise tolerance. He was then referred for coronary angiography that revealed mid-left anterior descending myocardial bridging with initial normal resting full-cycle ratio of 0.92. Further workup after ruling out coronary microvascular disease demonstrated abnormal hyperaemic full-cycle ratio of 0.80 with a diffuse rise across the myocardial bridging segment on pullback. Our patient also had increased spastic response to hyperaemia on angiography, supporting the presence of underlying endothelial dysfunction and ischaemia, likely contributing to his exertional symptomology. The patient was started on beta-blocker therapy with improvement in symptoms and resolution of chest pain on follow-up.
CONCLUSION
Our case highlights the importance of thorough workup of myocardial bridging in symptomatic patients to better understand the underlying physiology and endothelial function after ruling out microvascular disease and consideration of hyperaemic testing if symptoms are suggestive of ischaemia.
PubMed: 36793933
DOI: 10.1093/ehjcr/ytad047 -
Hellenic Journal of Cardiology : HJC =... Mar 2024
PubMed: 38453015
DOI: 10.1016/j.hjc.2024.03.007 -
Journal of Cardiovascular Disease... Apr 2012Myocardial bridging is a congenital coronary anomaly with a variety of clinical manifestations. Traditionally, myocardial bridging has been considered a benign...
Myocardial bridging is a congenital coronary anomaly with a variety of clinical manifestations. Traditionally, myocardial bridging has been considered a benign condition, but some cases of myocardial ischemia, infarction and sudden cardiac death due to myocardial bridging have been reported. Various studies have suggested that in their intramyocardial segments, these vessels are protected from obstructive atherosclerosis, with atherosclerosis being present in the proximal part of the artery. We report a case in a 45-year-old male who had a 2.5-cm long myocardial bridging over the left anterior descending artery, with obstructive atherosclerosis being present in the proximal as well as the intramyocardial part (part of the artery below the myocardial bridge). Atherosclerosis occurring in the intramyocardial segment is a rare occurrence, and combined with systolic narrowing by the myocardial bridge can lead to ischemia of the cardiac musculature.
PubMed: 22629044
DOI: 10.4103/0975-3583.95380 -
Translational Pediatrics Apr 2019Critical congenital heart disease (cCHD) is the most common reason for acute cardiac failure in the neonatal period. cCHD, defined by systemic low cardiac output (LCO)... (Review)
Review
Critical congenital heart disease (cCHD) is the most common reason for acute cardiac failure in the neonatal period. cCHD, defined by systemic low cardiac output (LCO) and requiring surgery or catheter-based intervention in the first year of life, has an incidence of approximately 15% of CHD and is responsible for up to 25% fatalities of newborn infants. Clinical deterioration develops in most cases due to rapid closure of the ductus arteriosus (DA). Early diagnosis and immediate treatment determinate beneficial outcome. Critical CHD can be classified in duct-dependent systemic flow, duct-dependent pulmonary flow and transposition of the great arteries. The latter two manifest themselves in oxygen resistant cyanosis, whereas CHD with duct-dependent systemic flow may present itself with cardiogenic shock, which can be difficult to differentiate from other causes of shock such as sepsis. Besides prostaglandin therapy for reopening the arterial duct, a balanced parallel pulmonary and systemic circulation should be a therapeutic goal. In CHD with duct-dependent systemic flow a decrease of pulmonary resistance should be avoided; therefore inadequate oxygen therapy, hyperventilation and alkalosis due to excessive treatment of acidosis, should be averted. Volume therapy should be performed carefully. In CHD with duct-dependent pulmonary flow, pulmonary resistance can be decreased, in case of poor pulmonary flow systemic resistance should be increased, mild alkalosis is recommended. Intense volume therapy is in most cases necessary, except if a restrictive atrial communication is present. In addition to intensive care measures, an arsenal of catheter- and surgery-based procedures need to be hold available as back-up for emergency procedures. Transcatheter interventions are nowadays decisive. Atrial-septostomy was the first and still the most utilized high-urgency procedure; DA-stenting is used in prostaglandin-refractory duct stenosis. In the presence of critical aortic valve stenosis, palliation consists of balloon valvuloplasty. In critical aortic coarctation with myocardial failure and no response to prostaglandin, palliative balloon angioplasty may be the method of choice as bridging for corrective surgery.
PubMed: 31161078
DOI: 10.21037/tp.2019.04.06 -
Radiology Case Reports Jul 2022Myocardial bridging occurs when a segment of major epicardial coronary artery courses intramurally through myocardium, commonly involving the left anterior descending....
Myocardial bridging occurs when a segment of major epicardial coronary artery courses intramurally through myocardium, commonly involving the left anterior descending. However, myocardial bridging involving coronary arteries other than left anterior descending is less-common and rarely reported, especially in the elderly population. We report a rare case of multiple myocardial bridging involving the left anterior descending, first obtuse marginal, and ramus intermedius in a 68-year-old Asian female. We also briefly discuss the imaging evaluation and pathophysiology of myocardial ischemia in myocardial bridging. This is the second reported case of myocardial bridging involving such combination, and to our knowledge, the first for elderly patient.
PubMed: 35601387
DOI: 10.1016/j.radcr.2022.04.018 -
World Journal of Clinical Cases Oct 2022Myocardial bridging is a common anatomical malformation, and the milking effect is a characteristic phenomenon of myocardial bridging in coronary angiography. Generally,...
BACKGROUND
Myocardial bridging is a common anatomical malformation, and the milking effect is a characteristic phenomenon of myocardial bridging in coronary angiography. Generally, the phenomenon is invariable. However, this article reports an inconceivably rare myocardial bridging phenomenon that breaks through our conventional views. The milking effect changed obviously in two coronary angiography examinations, which subverted the traditional deep-rooted view of the myocardial bridging phenomenon and revealed the limitations of coronary angiography in diagnosing myocardial bridging and judging the prognosis of it.
CASE SUMMARY
A 63-year-old man was diagnosed with ST-segment elevation myocardial infarction and received primary percutaneous coronary intervention on December 26, 2019. His heart rate was 104 beats per minute, and blood pressure was 15.3/10.3 kPa. A severe milking effect was found in the left anterior descending coronary artery during his index coronary angiography on January 14, 2020. The patient was given intensive medical management, including a β1-adrenergic receptor blocker, during hospitalization and after discharge. Unexpectedly, coronary angiography showed that the previous impressive milking effect was dramatically alleviated (close to normal) at the follow-up on October 13, 2020. At that moment, the patient's heart rate was 83 beats per minute, and blood pressure was 12.7/8.0 kPa.
CONCLUSION
The myocardial bridging phenomenon is not invariable and, in certain circumstances, may vary. Furthermore, the autonomic nervous system may be involved in the myocardial bridging phenomenon.
PubMed: 36312505
DOI: 10.12998/wjcc.v10.i29.10721 -
Netherlands Heart Journal : Monthly... Feb 2005Isolated systolic compression of the mid portion of the left anterior descending artery (LAD) by a bridge of overlying cardiac muscle is an infrequent but...
Isolated systolic compression of the mid portion of the left anterior descending artery (LAD) by a bridge of overlying cardiac muscle is an infrequent but well-recognised angiographic anomaly that is often considered harmless. The long-term prognosis appears to be excellent, but occasional reports of patients with angina pectoris, myocardial infarction and sudden death indicate that this is not always true. The prevalence of the anomaly in the normal population is unknown, but the incidence is low and ischaemic events are rare. Tako-tsubo-like left ventricular dysfunction syndrome (TTS) is characterised by ischaemia, anterior ST-segment elevation, no significant coronary artery disease and reversible ampulla-like left ventricular ballooning in postmenopausal females after emotional or physical stress. Dynamic left ventricular outflow tract (LVOT) obstruction is a rare but potentially fatal complication of acute anterior wall infarction. We present a patient with an acute coronary syndrome (ACS) with ST-segment elevation in the anterior leads, transient TTS and transient LVOT obstruction with systolic anterior motion (SAM) of the mitral valve and severe mitral regurgitation. This is the first report of myocardial bridging associated with TTS, and the first report of TTS associated with dynamic LVOT obstruction with SAM and mitral regurgitation.
PubMed: 25696451
DOI: No ID Found -
American Journal of Physiology. Heart... Dec 2019Myocardial bridging (MB) is linked to angina and myocardial ischemia and may lead to sudden cardiac death in patients with hypertrophic cardiomyopathy (HCM). However, it...
Myocardial bridging (MB) is linked to angina and myocardial ischemia and may lead to sudden cardiac death in patients with hypertrophic cardiomyopathy (HCM). However, it remains unclear how MB affect the coronary blood flow in HCM patients. The aim of this study was to assess the effects of MB on coronary hemodynamics in HCM patients. Fifteen patients with MB (7 HCM and 8 non-HCM controls) in their left anterior descending (LAD) coronary artery were chosen. Transient computational fluid dynamics (CFD) simulations were conducted in anatomically realistic models of diseased (with MB) and virtually healthy (without MB) LAD from these patients, reconstructed from biplane angiograms. Our CFD simulation results demonstrated that dynamic compression of MB led to diastolic flow disturbances and could significantly reduce the coronary flow in HCM patients as compared with non-HCM group ( < 0.01). The pressure drop coefficient was remarkably higher ( < 0.05) in HCM patients. The flow rate change is strongly correlated with both upstream Reynolds number and MB compression ratio, while the MB length has less impact on coronary flow. The hemodynamic results and clinical outcomes revealed that HCM patients with an MB compression ratio higher than 65% required a surgical intervention. In conclusion, the transient MB compression can significantly alter the diastolic flow pattern and wall shear stress distribution in HCM patients. HCM patients with severe MB may need a surgical intervention. In this study, the hemodynamic significance of myocardial bridging (MB) in patients with hypertrophic cardiomyopathy (HCM) was investigated to provide valuable information for surgical decision-making. Our results illustrated that the transient MB compression led to complex flow patterns, which can significantly alter the diastolic flow and wall shear stress distribution. The hemodynamic results and clinical outcomes demonstrated that patients with HCM and an MB compression ratio higher than 65% required a surgical intervention.
Topics: Adolescent; Adult; Aged; Cardiomyopathy, Hypertrophic; Coronary Circulation; Female; Hemodynamics; Humans; Male; Middle Aged; Models, Cardiovascular; Myocardial Bridging; Patient-Specific Modeling
PubMed: 31674812
DOI: 10.1152/ajpheart.00466.2019