Egzersiz ile şiddetlenen göğüs ağrısının nadir bir nedeni olarak Dunbar sendromu

Özet Medyan arkuat ligaman T12/L1 vertebra seviyesin- de aortik hiatusu çaprazlayan sağ ve sol diyafram kruslarını birbirine bağlayan fibröz bir bağdır. Az sayıda hastada bu ligamanın düşük seviyeli yerleşimi çölyak arterin proksima- linde ciddi darlığa neden olarak çölyak arter bası sendromu olarak bilinen iskemik semptomlara yol açar. Bu durum ay- rıca medyan arkuat ligaman sendromu ya da Dunbar send- romu olarak da bilinir. Semptomlar arasında özellikle yemek sonrasında gelişen epigastrik ya da retrosternal ağrı, kilo kaybı, bulantı, kusma, ishal ve iştahsızlık sayılabilir. Ciddi olgularda egzersiz sırasında kan akımının cilde ve kaslara yönlenmesine bağlı olarak gelişen çalma fenomeni sonu- cunda egzersiz ile ilişkili karın ağrısı gözlenebilir. Bilgisayarlı tomografik anjiyografi mezenter anjiyografi ile birlikte çölyak arter bası sendromu tanısında altın standart tanı yöntemi- dir. Medyan arkuat ligamanın cerrahi tedavi ile gevşetilmesi genellikle ilk tercih edilen tedavi seçeneğidir. Burada ye- meklerden sonra olan ve özellikle egzersiz ile şiddetlenen epigastrik bölgeye de yayılan retrosternal ağrı şikayeti ile başvuran 46 yaşında erkek hastada koroner semptomları ile de karışabilecek çölyak arter bası sendromu sunuldu.Summary The median arcuate ligament is a fibrous band connecting the left and right diaphragmatic crura across the aortic hiatus at the level of the T12/L1 vertebral bodies. The low insertion point of this ligament causes significant stenosis of the proximal portion of the coeliac artery in a small group of patients, and contributes to ischemic symptoms known as coeliac artery compression syndrome (CACS). It is also re- ferred to as median arcuate ligament syndrome or Dunbar syndrome. Symptoms include especially postprandial epi- gastric or retrosternal pain, weight loss, nausea, vomiting, diarrhea and reduced appetite. In severe cases, exercise re- lated abdominal pain may be caused by steal phenomenon, whereby blood is shunted to the skin and relevant muscles during exercise. Computed tomographic angiography and mesenteric angiography are the gold standard diagnostic modalities to confirm diagnosis of CACS. Surgical therapy with release of the median arcuate ligament usually is the primary treatment of choice. Here, we present a 46-year-old male CACS patient with postprandial and especially exer- cise-induced retrosternal pain radiating to the epigastric re- gion, which may be misperceived as a coronary symptom

Obstructive Prosthetic Mitral Valve Thrombosis Successfully Thrombolysed with Low-Dose Ultra-Slow Infusion of Tissue Plasminogen Activator

Prosthetic valve thrombosis (PVT) is one of the major causes of posthetic heart valve failure. Treatment modalities for this rare but life threatening complication include anticoagulation with heparin, thrombolytic therapy (TT) and re-do valve surgery. Guidelines lack definitive class I recommendations due to lack of randomised controlled trials, and usually leave the choice of treatment to the clinician’s experience. Surgery is suggested as a first line strategy in most situations of left sided PVT; however, TT has been recently used with successful outcomes1-3. This report describes a patient with giant thrombus located on the prosthetic mitral valve, which was succesfully treated with ultraslow infusion (25 hours) of low dose (25 mg) tissue plasminogen activator (tPA) under the guidance of two-dimensional (2D) and real-time three-dimensional (RT -3D) transesophageal echocardiography (TEE) and fluoroscopy

A rare Congenital Coronary Artery Anomaly: Woven Right Coronary Artery associated with Myocardial Infarction

Woven coronary artery (WCA) is an extremely rare and still not a clearly defined coronary anomaly. It is characterized by the division of epicardial coronary artery into thin channels which then reanastomose with the distal part of the abnormal coronary artery [1]. Since the angiographic imaging of WCA looks like an intracoronary thrombus and dissection; the differential diagnosis between atherothrombotic coronary arteries with recanalization of organized thrombi in coronary arteries and WCA may be very difficult for invasive cardiologists, especially in patients with single or two coronary artery involvements [2]