Akram Abu-Ful

Left anterior descending artery length in left and right coronary artery dominance

BackgroundCoronary stenosis of the left anterior descending artery (LAD) is respected by cardiologists because of its negative influence on morbidity and mortality. An important anatomical consideration is the length of the LAD. ObjectiveTo investigate the relationship between length of LAD and coronary dominance. DesignRetrospective comparison of 100 consecutive angiograms with left coronary dominance with 100 consecutive angiograms with right coronary dominance. The relationship between the length of the LAD and coronary dominance was analyzed. MethodsWe retrospectively compared 100 consecutive angiograms with left coronary dominance (the posterior descending artery being supplied by the circumflex artery) with 100 consecutive angiograms with right coronary dominance (the posterior descending artery being supplied by the right coronary artery). LADs were categorized into three types: type A, LAD terminating before the cardiac apex; type B, LAD reaching the apex but not supplying the inferoapical segment of the left ventricle; and type C, LAD wrapping around the apex and supplying the inferoapical segment. LAD typing was also analyzed in relation to gender. ResultsIt was found that the LAD wrapped around the apex in 87% of cases of left coronary dominance but only in 47% of patients with right coronary dominance, and that the long LADs were more frequently seen in women than in men, irrespective of coronary dominance. ConclusionsWe found that the LAD in left coronary dominance is usually long and wraps around the apex, and believe that angiographic interventions in such cases have important clinical significance.

Thrombolytic therapy in acute pancreatitis presenting as acute myocardial infarction

In the treatment of patients with suspected acute myocardial infarction, the use of thrombolytic therapy could be coined as ‘the race against time’, as rapid implementation of thrombolysis may save myocardial mass and decrease mortality. In cases having typical clinical presentations and ECG changes, a rapid and accurate therapeutic decision must be made. In patients with atypical clinical signs and ECG recordings, the chronologic urgency may force a decision concerning the use of thrombolysis while the diagnosis is uncertain. In these circumstances, thrombolytic therapy may be dangerous, particularly in cases of aortic dissection, pericarditis and gastrointestinal tract pathology. Gastrointestinal disorders presenting with epigastric pain are an important part of the differential diagnosis of myocardial infarction. In this situation, the ECG

Prolonged catheter-induced coronary artery spasm mimicking fixed stenosis.

Two cases of prolonged catheter-induced right coronary artery spasm, mimicking fixed stenoses, are presented. In one case, the spasm appeared at the same place in sequential catheterizations. This angiographic finding may be easily misinterpreted as a fixed lesion, leading to unnecessary attempts at angioplasty.

Unusual bleeding complications of thrombolytic therapy after cardiopulmonary resuscitation: Three case reports

The authors present three case reports retrospectively casting doubt on the benefit of thrombolysis after external cardiac massage.

Unusual coronary collateral circulation: filling of a totally occluded left anterior descending artery by direct continuity from a left posterior descending artery. A case report.

A patient with an unusual coronary collateral circulation is presented. The left anterior descending artery, which was totally occluded proximally, was filled directly by a contin uation of the left posterior descending artery. A thallium stress test revealed normal perfusion in the territory of the left anterior descending artery.

Coronary stenting with AVE microstents in acute myocardial infarction

Of 36 patients with acute myocardial infarction (AMI) who were referred for direct or rescue coronary angioplasty, 11 (31%) needed stent implantation. In 7 of them, the stent was implanted because of severe dissection and in 4, because of elastic recoil. All patients were discharged without clinical or electrocardiographic signs of reocclusion. No death, reinfarction or clinical evidence of ischemia occurred during up to 15 months of follow-up.