Congenital left main coronary artery aneurysm

Left main coronary artery aneurysm (LMCAA) is an uncommon coronary abnormality seen in 0.1% of patients during routine diagnostic coronary angiographies. The most common etiology is atherosclerosis in acquired cases. However, it can also be a congenital malformation. We present the case of a 26 year-old female with a large LMCAA. She was diagnosed with tetralogy of Fallot initially. (Cardiol J 2011; 18, 4: 430–433

Clinical and echocardiographic features of children with rheumatic carditis: correlation with high sensitivity C-reactive protein.

Background: Rheumatic fever (RF) and rheumatic heart disease (RHD) are leading causes of cardiovascular mortality and morbidity in developing countries.Objectives: To describe the clinical and echocardiographic features of children with RF and RHD and compare these features with their serum C-reactive protein in 2 pediatric cardiology centers in Khartoum.Methodology: It was a prospective cross sectional study. Patients were examined clinically and by echocardiography. Serum high sensitivity C-reactive protein (hsCRP) was measured from children with Acute RF as well as from healthy age and sex matched controls selected from children attending the clinics. Statistical Analysis Used: Mean and standard deviation, P value using Fisher’s exact test.Results: Sixty six patients (45% males) were enrolled. Mitral regurgitation (MR) was found in 65 patients (98%), it was severe in 42 patients (64%), combined with aortic regurgitation (AR) in 27 patients (41%) and with Mitral stenosis (MS) in 3 patients (4.5%). For patients with carditis, hsCRP ranged between 1.10 and 15 mg/l (mean 8.0817, SD 4.47). In the control group it was 0.6-1.3 mg/l (mean 0.93 SD 0.23) P<0.0001.Patients with Acute RF had hsCRP mean of 12.35 mg/l (SD 2.11) while those with chronic RHD had hsCRP mean of 7.34 mg/l (SD 4.16), P<0.0001.Conclusion: RHD is manifested in our patients with severe valve damage dominated by MR and there is evidence of an ongoing inflammation during the chronic phase. RHD is manifested in a severe form in Sudan. High sensitivity CRP is elevated in acute phase as well as in the chronic phase.Key Words: Rheumatic carditis, C-reactive protein

Percutaneous coronary intervention in a patient with single coronary artery

AbstractCoronary artery anomalies are found in 1–5% of all coronary angiograms. Single coronary artery is a rare congenital anomaly. The prevalence of the anomaly is 0.024–0.066% of the general population and percutaneous coronary intervention in this anomaly is performed infrequently. The highest incidence of this condition is reported from India. We report a case of a 55 year old patient of anterior wall ST elevation myocardial infarction with L1 group of single coronary artery who underwent successful angioplasty and stenting to left anterior descending artery. The unique features and inherent risks of percutaneous coronary intervention to single coronary artery are discussed

Sex differences in diameter of the coronary sinus ostium: Correlation with weight of the heart

Diameter of the coronary sinus ostium is important in the designing of cannulation devices used in cardiac resynchronization  therapy and percutaneous mitral valve annuloplasty. Population variation of the diameter may account for the failure rate of these procedures. Studies of the coronary sinus ostium from African populations are scarce and altogether absent for Kenya. Therefore, this study aimed at determining sex differences in the diameter of coronary sinus ostium and its correlation with the weight of the heart. Seventy-four hearts of adult black Kenyans [43 male, 31 females; age range 20 – 70 years] obtained during autopsy at the Department of Human Anatomy, University of Nairobi, Kenya were weighed. The coronary sinus ostium was identified and its   transverse and supero-inferior diameters measured in millimeters. The measurements were analyzed using SPSS version 17. Sex  comparison was established using student’s t test. Association between diameter and heart weight was established using  Pearson’s correlation test and considered significant at a p-value of ≤0.05. Data were presented using scatter plots. Transverse and supero-inferior diameters of the ostium were 11.04±1.88mm and 9.50±1.80mm respectively. The mean diameter was 10.27 mm. These correlated positively with weight of the heart. When corrected for weight of the hearts, the transverse and supero-inferior diameters were larger in females (0.042 and 0.036 respectively) than in males (0.034 and 0.03 respectively). The diameter of coronary sinus ostium is larger in females and shows positive correlation with weight of the heart. These data should be considered during design and use of cardiac devices introduced through the coronary sinus.Key words: Coronary sinus, ostium, diameter, sex difference

Prevention of Radiocontrast-Induced Nephropathy after Coronary Angiography: N-Acetylcysteine plus Saline Hydration versus Saline Hydration

Purpose: To compare the incidence of radiocontrast-induced nephropathy (RCIN) in patients undergoing coronary angiography pretreated with N-acetylcysteine NAC plus saline hydration or saline hydration alone and to determine the association between various risk factors and RCIN.Methods: Patients were retrospectively evaluated over a one-year period. RCIN was defined as an acute rise in serum creatinine of at least 0.5 mg/dl or more than 25 % from baseline value. SPSS software, version 13 was used for data analysis.Results: Overall, 299 patients were studied. Thirteen patients (4.3%) developed RCIN. RCIN was 3.3 % in patients treated with hydration, and 8.3 % in patients treated with NAC plus hydration (p = 0.09). Inpatients with RCIN, the changes in creatinine and % change in creatinine after 24 h were significantly lower in the NAC plus hydration group (p = 0.039 and p = 0.042, respectively). RCIN was significantly associated with male gender (p = 0.017), history of renal failure (p = 0.006), ischemic heart disease (p =0.003), and diuretic treatment (p = 0.013).Conclusion: NAC plus saline hydration may not be more effective than saline hydration alone in decreasing RCIN after coronary angiography. Additional efforts to find an ideal preventive treatment are needed

Identification of clinical risk factors of atrial fibrillation in congestive heart failure

Background: Factors associated with the development of atrial fibrillation (AF) in generalpopulation have been described, but it is still unknown whether the same risk factors applyto heart failure (HF) patients. The aim of this study was to identify clinical factors related tovarious forms of AF in HF patients.Methods: The clinical and echocardiographic characteristics were assessed in 155 HF patients:50 with sinus rhythm, 52 with non-permanent AF, and 53 with permanent AF.Results: Multivariate logistic regression analysis showed that the increase in the NYHAclass was an independent risk factor for both forms of AF. The occurrence of permanent AF incomparison to sinus rhythm group was independently associated with hs-C-reactive protein(CRP) elevation above 1 mg/dL (OR 1.87, 95% CI 1.05–3.35), left atrial dimension above4 cm (OR 3.78, 95% CI 1.29–11.06) and tricuspid maximal pressure gradient elevation above35 mm Hg (OR 5.01, 95% CI 1.38–18.27). The presence of coronary disease was independentlyassociated with less frequent occurrence of permanent AF in comparison to sinus rhythm group(OR 0.21, 95% CI 0.06–0.67).Conclusions: More advanced congestive HF was associated with presence of both types of AF.Non-ischemic etiology of HF and elevated CRP are independently associated with permanentAF compared to sinus rhythm. Left ventricular diastolic dysfunction indicators (increasedtricuspid maximal pressure gradient and left artial dimension) are independently associatedwith permanent AF

Evaluation of atrial electromechanical conduction delay in case of hemodynamically insignificant rheumatic heart disease: A tissue Doppler study

Background: Atrial electromechanical delay (AEMD) that reflects delayed conduction may show us the clinical reflection of pathological changes in the atria. The main objective of the present study is to investigate AEMD in patients who had previous rheumatic carditis but without hemodynamically significant valvular disease. Methods: A total of 40 patients, previously diagnosed as rheumatic carditis but without significant valvular stenosis/regurgitation and atrial enlargement; and 39 age- and-sex matched controls were enrolled for the present study. Parameters of AEMD (lateral mitral annulus electromechanical delay, septal mitral annulus electromechanical delay and lateral tricuspid annulus electromechanical delay) were measured with tissue Doppler echocardiography and left intra-atrial and inter-atrial conduction times were calculated accordingly. A 24h ambulatory Holter monitoring was used in both groups to detect atrial fibrillation episodes and quantify atrial extrasystoles. Results: Parameters of AEMD, including left intra-atrial and inter-atrial conduction times of subjects in the study group were longer compared to the control group (23.7 ± 7.0 vs. 18.3 ± 6.2). Conclusions: Increased AEMD is observed in patients with previous rheumatic carditis and no significant valvular stenosis/regurgitation and atrial enlargement, which may partly explain the increased incidence of atrial fibrillation observed in these patients

Biomarcadores y práctica clínica

Uno de los mayores retos de la medicina actual es intentar predecir o estimar el riesgo de sufrir un evento patológico en una persona sana o un paciente concreto. De ahí el interés creciente en el papel de los biomarcadores diagnósticos y pronósticos que puedan ser identificados en sangre. El National Institutes Health (NIH) estableció la definición de biomarcador como aquellas características biológicas, bioquímicas, antropométricas, fisiológicas, etc., objetivamente mensurables, capaces de identificar procesos fisiológicos o patológicos, o bien una respuesta farmacológica a una intervención terapéutica. Existen diferentes tipos de biomarcadores: diagnósticos, pronósticos, o terapéuticos1. El biomarcador ideal debe ser específico, sensible, predictivo, rápido y económico, estable in vivo e in vitro, no invasivo, y que tenga suficiente relevancia preclínica y clínica como para modificar las decisiones relativas al proceso patológico en que se aplica. El artículo de Calvo-Rodríguez y col en este número, analiza el papel de la proteína C reactiva (PCR) como marcador de isquemia intestinal y sugiere su utilidad para estimar la gravedad en la oclusión intestinal. Algunos estudios han demostrado un incremento de la concentración de PCR dependiente de la gravedad de la translocación bacteriana en la obstrucción intestinal aguda. Es probable que la pérdida de la función de barrera del epitelio intestinal en estas tres situaciones clínicas explique el valor predictivo que la concentración sérica de PCR ha demostrado..

Aspectos Epidemiológicos, Etiologia e Classificaçao da Fibrilaçao Atrial

A fibrilaçao atrial (FA) é a arritmia sustentada mais freqüente. Sua prevalência é rara antes dos 40 anos, mas, aumenta progressivamente a partir desta idade. Como a proporçao de idosos está crescendo, a sua ocorrência será cada vez mais freqüente. O seu aparecimento está relacionado a aumento de duas vezes na mortalidade e de 5 vezes nos acidentes vasculares cerebrais. As causas mais freqüentes sao a cardiopatia hipertensiva, a insuficiência cardíaca, as valvopatias mitrais e a insuficiência coronariana. Outras causas sao a tireotoxicose, doenças pulmonares obstrutivas, distúrbios eletrolíticos, stress, álcool, cardiomiopatia hipertrófica, Wolf-Parkinson-White, valvopatia aórtica, cardiopatia chagásica, doença do nó sinusal etc. Cerca de 15 a 30% nao apresentam causas definidas (FA isolada). Nao existe uma classificaçao consensual para a FA. De acordo com o tempo de evoluçao, a FA pode se