Right internal mammary artery for the management of anomalous right coronary artery from the left sinus of Valsalva; a case report

Background: Anomalous origin of the right coronary artery from the left sinus of Valsalva (ARCA) is a rare anomaly. Surgery is recommended in symptomatic patients, while the optimal surgical approach is controversial. Case presentation: We present a case of an ARCA in a 56-year-old male who was managed with coronary artery bypass grafting using the right internal mammary artery and ligation of the proximal right coronary artery.  The patient remained asymptomatic after 1 year of follow-up. Conclusions: ARCA can be managed using the right internal mammary artery with ligation of the proximal right coronary artery to prevent the competitive flow

Composite Y internal thoracic artery–saphenous vein grafts: short-term angiographic results and vasoreactive profile

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The role of 3D echocardiographic imaging in the differential diagnosis of an atypical left atrial myxoma

We describe a case of a left atrial myxoma atypical for its anatomical features and site of attachment. Although an initial multimodality imaging was performed, the diagnosis of myxoma was possible only by three dimensional echocardiography (3DE) which was able to identify the pedicle and the attachment at the base of the interatrial septum, close to the origin of right inferior pulmonary vein. In fact the 3DE can electronically section the structures and obtain unique planes useful in visualizing correctly the anatomical features of the myxomas and as a result, it facilitates the surgical decision planning. Even the anatomical appearance was uncommon at surgery and the diagnosis could be confirmed only by pathology.  This case highlights the diagnostic ability of the 3DE in similar challenging scenarios.

A Case of Shunting Postoperative Patent Foramen Ovale under Mechanical Ventilation Controlled by Different Ventilator Settings

A 56-year old male with ischemic heart disease and an unremarkable preoperative echocardiogram underwent surgical coronary revascularization. An intraoperative post pump trans-esophageal echocardiogram (TOE) performed while the patient was being ventilated at a positive end expiratory pressure (PEEP) of 8 cm H2O demonstrated a right to left interatrial shunt across a patent foramen ovale (PFO). Whereas oxygen saturation was normal, a reduction of the PEEP to 3 cm H2O led to the complete resolution of the shunt with no change in arterial blood gases. Attempts to increase the PEEP level above 3 mmHg resulted in recurrence of the interatrial shunt. The remaining of the TEE was unremarkable. Mechanical ventilation, particularly with PEEP, causes an increase in intrathoracic pressure. The resulting rise in right atrial pressure, mostly during inspiration, may unveil and pop open an unrecognized PFO, thus provoking a right to left shunt across a seemingly intact interatrial septum. This phenomenon increases the risk of paradoxical embolism and can lead to hypoxemia. The immediate management would be to adjust the ventilatory settings to a lower PEEP level. A routine search for a PFO should be performed in ventilated patients who undergo a TEE

A case of shunting postoperative patent foramen ovale under mechanical ventilation controlled by different ventilator settings

A 56-year old male with ischemic heart disease and an unremarkable preoperative echocardiogram underwent surgical coronary revascularization. An intraoperative post pump trans-esophageal echocardiogram (TOE) performed while the patient was being ventilated at a positive end expiratory pressure (PEEP) of 8 cm H2O demonstrated a right to left interatrial shunt across a patent foramen ovale (PFO). Whereas oxygen saturation was normal, a reduction of the PEEP to 3 cm H2O led to the complete resolution of the shunt with no change in arterial blood gases. Attempts to increase the PEEP level above 3 mmHg resulted in recurrence of the interatrial shunt. The remaining of the TEE was unremarkable. Mechanical ventilation, particularly with PEEP, causes an increase in intrathoracic pressure. The resulting rise in right atrial pressure, mostly during inspiration, may unveil and pop open an unrecognized PFO, thus provoking a right to left shunt across a seemingly intact interatrial septum. This phenomenon increases the risk of paradoxical embolism and can lead to hypoxemia. The immediate management would be to adjust the ventilatory settings to a lower PEEP level. A routine search for a PFO should be performed in ventilated patients who undergo a TEE

Postoperative coronary artery spasm after mitral valve replacement

Introduction: Postoperative coronary artery spasm is an infrequent life-threatening event after cardiac surgery which can occur without an underlying coronary disease Presentation of case: We report a documented case of a 67-year-old man with normal coronary arteries submitted to mitral valve replacement. Immediately after surgery he had a ST elevation in the inferior leads, and an inferior wall hypokinesia at the trans-oesophageal echo. A coronary angiography demonstrated a focal spasm in the right coronary artery which was successfully treated by intracoronary injection of nitrates. The following postoperative course was uneventful and the left ventricular function returned to normal. Discussion: A coronary artery spasm should be suspected whenever a postoperative infarction occurs after valvular surgery especially in absence of associated coronary artery disease. In this cases postoperative coronary angiography allows both the diagnosis and the treatment. Conclusion: This case-report summarizes the findings of this rare and potentially life-threatening cause of early postoperative ischemia and highlights the role of early coronary angiography in the cases of suspected myocardial infarction after cardiac surger

New (Anilidomethyl)pyridine Titanium(IV) and Zirconium(IV) Catalyst Precursors for the Highly Chemo- and Stereoselective cis-1,4-Polymerization of 1,3-Butadiene

Group 4 metals complexes bearing anilidomethylpyridine ligands have been synthesized and characterized by NMR spectroscopy, elemental anal., and single-crystal X-ray diffraction anal. All complexes, after activation by using AliBu2H and methylalumoxane (MAO) were tested in 1,3-butadiene and α-olefins polymn. The zirconium complexes showed higher activity with respect to the titanium homologous. Polymn. of ethylene resulted, in all cases in the prodn. of high mol. wt. linear polyethylene. Propylene polymn. tests provided substantially atactic polypropylene. 1,3-Butadiene polymns. produced cis-1,4 polybutadiene, and in the case of zirconium complexes polymers with a content of cis-1,4 units higher a 99.9% were provided. Activity and stereoselectivity of the catalysts were related to the steric features of the complexes