Spontaneous left main coronary artery dissection complicated by pseudoaneurysm formation in pregnancy: role of CT coronary angiography

We report a case of a 26-year-old female, who presented at 34 weeks of an uncomplicated pregnancy with an acute ST elevation anterior wall myocardial infarction. Cardiac catheterization suggested a left main coronary artery dissection with pseudoaneurysm formation. The patient's course was complicated by congestive heart failure. She was initially managed conservatively by a multidisciplinary team including heart failure specialists, obstetricians, and cardiovascular surgeons. 4 days after admission, her LMC was imaged by dual-source 64 slice Cardiac computed tomography, coronary dissection was identified extending to the lumen, and the presence of pseudoaneurysm was confirmed. She underwent subsequently a staged procedure, which included placement of an intra-aortic balloon pump, cesarean section, and coronary artery bypass grafting. This case illustrates the utility of coronary artery CT imaging to assess the complexity and stability of coronary artery dissections, thereby helping to determine the need for, and timing of revascularization procedures

Candidate genetic analysis of plasma high-density lipoprotein-cholesterol and severity of coronary atherosclerosis

<p>Abstract</p> <p>Background</p> <p>Plasma level of high-density lipoprotein-cholesterol (HDL-C), a heritable trait, is an important determinant of susceptibility to atherosclerosis. Non-synonymous and regulatory single nucleotide polymorphisms (SNPs) in genes implicated in HDL-C synthesis and metabolism are likely to influence plasma HDL-C, apolipoprotein A-I (apo A-I) levels and severity of coronary atherosclerosis.</p> <p>Methods</p> <p>We genotyped 784 unrelated Caucasian individuals from two sets of populations (Lipoprotein and Coronary Atherosclerosis Study- LCAS, N = 333 and TexGen, N = 451) for 94 SNPs in 42 candidate genes by 5' nuclease assays. We tested the distribution of the phenotypes by the Shapiro-Wilk normality test. We used Box-Cox regression to analyze associations of the non-normally distributed phenotypes (plasma HDL-C and apo A-I levels) with the genotypes. We included sex, age, body mass index (BMI), diabetes mellitus (DM), and cigarette smoking as covariates. We calculated the q values as indicators of the false positive discovery rate (FDR).</p> <p>Results</p> <p>Plasma HDL-C levels were associated with sex (higher in females), BMI (inversely), smoking (lower in smokers), DM (lower in those with DM) and SNPs in <it>APOA5, APOC2</it>, <it>CETP, LPL </it>and <it>LIPC </it>(each q ≤0.01). Likewise, plasma apo A-I levels, available in the LCAS subset, were associated with SNPs in <it>CETP</it>, <it>APOA5</it>, and <it>APOC2 </it>as well as with BMI, sex and age (all q values ≤0.03). The <it>APOA5 </it>variant S19W was also associated with minimal lumen diameter (MLD) of coronary atherosclerotic lesions, a quantitative index of severity of coronary atherosclerosis (q = 0.018); mean number of coronary artery occlusions (p = 0.034) at the baseline and progression of coronary atherosclerosis, as indicated by the loss of MLD.</p> <p>Conclusion</p> <p>Putatively functional variants of <it>APOA2</it>, <it>APOA5, APOC2</it>, <it>CETP, LPL</it>, <it>LIPC </it>and <it>SOAT2 </it>are independent genetic determinants of plasma HDL-C levels. The non-synonymous S19W SNP in <it>APOA5 </it>is also an independent determinant of plasma apo A-I level, severity of coronary atherosclerosis and its progression.</p

RELATIONSHIP BETWEEN MASKED ARTERIAL HYPERTENSION AND ERECTILE DYSFUNCTION

Backgroun

Efficacy and safety of routine aspiration thrombectomy during primary PCI for ST-segment elevation myocardial infarction: A meta-analysis of large randomized controlled trials

Background: Recent randomized controlled trials (RCTs) have questioned the clinical efficacy and safety of routine aspiration thrombectomy (AT) during primary percutaneous coronary intervention (PCI). A systematic synthesis of these randomized data is hence very timely to address this clinical equipoise. Methods: We performed a meta-analysis of the larger (>150 patients) RCTs that compared AT with only primary PCI. Procedural endpoints were myocardial blush grade (MBG) score of 0 or 1 and ST-segment resolution (STR) >50%. Midterm endpoints were mortality, reinfarction, target vessel revascularization, and stroke >30 days after the procedure. Results: We identified 11 large RCTs, with 10,309 patients randomized to AT and 10,296 to routine strategy (RT). While AT was associated with significantly improved myocardial perfusion, as demonstrated by the MBG score (OR = 0.69; p = 0.010), and improved rates of STR >50% (OR = 1.41; p = 0.006), there were no differences in mortality (OR = 0.89; p = 0.76), reinfarction (OR = 0.9; p = 0.47), target vessel revascularization (TVR; OR = 1.06; p = 0.67), and stroke rates (OR = 1.49; p = 0.29) >30 days after the procedure. Conclusion: Our meta-analysis of 20,605 patients who participated in large RCTs demonstrates improved MBG scores and STR >50% with AT compared with only PCI, but no differences were observed in mortality, reinfarction, TVR, and stroke rates at 30 days. Our study supports the latest ACC/AHA/SCAI focused update document that recommends against the routine use of AT during primary PCI. Keywords: Aspiration thrombectomy, Manual thrombectom

Optical coherence tomographic detection of cells and compositions

Provided herein are systems and methods for the detection of cells and/or compositions using optical coherence tomography. The systems and methods comprise a plurality of magnets for applying a plurality of distinct magnetic field strengths to the cells and/or compositions and a phase sensitive optical coherence tomographic imaging modality for detecting the cells and/or compositions while same are disposed in the presence of at least one of the plurality of distinct magnetic field strengths.Board of Regents, University of Texas Syste

Percutaneous Muscular Ventricular Septal Defect Closure with 2D Transthoracic Echocardiography: Can We Sufficiently Visualize It?

Ventricular septal defect (VSD) is one of the most common congenital heart diseases worldwide today. Although the majority close spontaneously, transcatheter VSD closure is a common option for symptomatic patients with suitable anatomy in adult age. Although transesophageal echocardiography (TEE) and intracardiac echocardiography are the most common imaging modalities for the procedure, in patients with poor TEE images, Transthoracic echocardiography (TTE) can be used as a reliable alternative. Here we present an adult patient with pulmonary hypertension associated with a muscular VSD which was closed percutaneously using 2-dimensional TTE because of poor TEE images