Kubilay Senen

Imaging of coronary artery anomalies: the role of multidetector computed tomography.

BackgroundCoronary artery anomalies are evaluated by using catheter-based angiography. Multidetector row-computed tomography (MDCT) is a new noninvasive imaging technique that has excellent spatial resolution for detecting the origin and course of a coronary anomalous vessel. ObjectiveTo determine the sensitivity of multidetector computed tomography in patients who had coronary artery anomaly demonstrated by conventional coronary angiography. Material and methodsA retrospective evaluation to identify 23 patients, who underwent retrospective electrocardiographic (ECG)-gated MDCT, was done and in whom an anomalous coronary vessel was found at a single center. Metoprolol (50–100 mg) was given orally to all patients to reduce heart rate so as to get high-quality MDCT images. After performing MDCT, the CT scans of each patient were analysed and compared with their coronary angiograms by two experienced radiologists and one cardiologist who were unaware about the study, and the sensitivity of MDCT was determined. ResultsTwenty-three patients (age range 28–73) with seven different coronary arteries of the anomalous type were evaluated. Nineteen patients had an anomalous left coronary artery; three patients had an anomalous single coronary artery; and one patient had an anomalous right coronary artery. The most common anomaly type was the left circumflex coronary artery (52%). The origin and course of all anomalous vessels were detected by ECG-gated MDCT (Lightspeed 16, GE Medical Systems, Milwaukee, Wisconsin, USA). The sensitivity of 100% of MDCT was detected in patients who had anomalous coronary vessels. ConclusionWe suggest that MDCT could be a non-invasive alternative imaging technique to conventional coronary angiography for screening the anomalous vessels of coronary arteries because of its excellent spatial resolution, which is very important for detecting the relationship of anomalous vessels with great arteries and cardiac structures.

P‐wave duration and P‐wave dispersion in patients with dilated cardiomyopathy

P‐wave dispersion (PWD) has been reported to be associated with inhomogeneous and discontinuous propagation of sinus impulses. In the present study, we aimed to investigate PWD in patients with dilated cardiomyopathy.

Increased P‐Wave Duration and P‐Wave Dispersion in Patients with Aortic Stenosis

Background: P‐wave dispersion (PWD), defined as the difference between the maximum and minimum P‐wave duration, has been proposed as being useful for the prediction of paroxysmal atrial fibrillation (AF). AF is the most common arrhythmia and an important prognostic indicator for clinical deterioration in patients with aortic stenosis (AS). The aim of the present study was to evaluate PWD in patients with AS.

Increased thrombolysis in myocardial infarction frame counts in patients with isolated coronary artery ectasia

The Thrombolysis in myocardial infarction (TIMI) frame count is a simple clinical tool for assessing quantitative indexes of coronary blood flow. This measurement has been significantly correlated with flow velocity measured with a flow-wire by several investigators during baseline conditions or hyperemia. In this study we aimed to evaluate the coronary flow in patients with isolated coronary artery ectasia by means of the TIMI frame count and to compare the results with those of patients with angiographically normal coronary arteries. The study population consisted of 37 patients with coronary artery ectasia only in the right coronary artery (RCA). The control group consisted of 31 patients with angiographically proven normal coronary arteries. Coronary artery ectasia was defined as nonobstructive lesions of the coronary arteries with a luminal dilatation 1.5-fold or more of the adjacent normal coronary segments. The TIMI frame count was determined for each major coronary artery in each patient according to the methods first described by Gibson et al. The TIMI frame count of RCA in the study group was significantly higher than in that of the control group (51 ± 17 vs 25 ± 8, P ≪ 0.0001). The TIMI frame counts of the study group for the left anterior descending and left circumflex coronary artery were also significantly higher than those of the control group (corrected TIMI frame count for LAD = 42 ± 11 vs 24 ± 7, P ≪ 0.001; TIMI frame count for LCx = 44 ± 15 vs 25 ± 9, P ≪ 0.001). In patients with coronary artery ectasia, the TIMI frame count of the RCA was higher than that of the left anterior descending and left circumflex coronary artery (51 ± 17 vs 42 ± 11 and 44 ± 15, respectively, P ≪ 0.05). We have shown increased TIMI frame counts in patients with isolated coronary artery ectasia and suggest that the pathophysiological mechanism of coronary artery ectasia is not a focal disease. TIMI frame counts can be regarded as an index of the severity of impaired coronary flow in patients with coronary artery ectasia.

Right coronary artery originating from distal left circumflex: an extremely rare variety of single coronary artery

Single coronary artery is a rare congenital anomaly of the coronary circulation which is often associated with other congenital cardiac malformations. Right coronary artery arising from the distal left circumflex artery is an extremely rare variety of single coronary artery. We report a patient with a single coronary artery system, in whom the right coronary artery originated from the distal left circumflex. No other associated cardiac anomaly was detected.

Imaging of coronary artery fistulas by multidetector computed tomography: is multidetector computed tomography sensitive?

Coronary angiography is the gold standard for diagnosing coronary artery fistulas (CAFs). Multidetector computed tomography (MDCT) is a recently developed imaging technique for detecting coronary artery stenosis, coronary artery anomalies, and coronary artery fistulas and their courses.

Documentation of slow coronary flow by the thrombolysis in myocardial infarction frame count in habitual smokers with angiographically normal coronary arteries

The thrombolysis in myocardial infarction (TIMI) frame count is a simple clinical tool for assessing quantitative indexes of coronary blood flow. In this study we aimed to evaluate the effects of long-term cigarette smoking on the TIMI frame count in patients with angiographically proven normal coronary arteries. Between May 2001 and January 2002, 41 habitual smokers and 41 sex-matched nonsmokers with angiographically proven normal coronary arteries were included in the study. The TIMI frame count was determined for each major coronary artery in each patient. The TIMI frame count of the smoking group was significantly higher than that of nonsmokers for all three coronary arteries: left anterior descending (corrected), 39 ± 13 vs 22 ± 8; right coronary artery, 35 ± 13 vs 24 ± 11; and left circumflex artery, 37 ± 13 vs 25 ± 8 (P < 0.001 for all). The smokers tended to be younger than nonsmokers ( 46 ± 7 vs 49 ± 9 years; P = 0.07). We have found that smokers with angiographically normal coronary arteries have a higher TIMI frame count than nonsmokers with angiographically normal coronary arteries. An increased TIMI frame count can be regarded as an index of the harmful effects of smoking on coronary circulation regardless of the underlying mechanism.

Double left anterior descending coronary artery arising from the left and right coronary arteries: a rare congenital coronary artery anomaly.

Double left anterior descending coronary artery arising from the left and right coronary arteries is a very rare congenital coronary artery anomaly. In this report, we describe a patient with double left anterior descending coronary artery originating from the left and right coronary arteries. To the best of our knowledge, dual connection of the left anterior descending coronary artery to the left and right coronary arteries has been described in only five patients.

Accessory mitral valve tissue manifesting cerebrovascular thromboembolic event in a 34-year-old woman

Accessory mitral valve tissue is an extremely rare congenital cardiac anomaly. Most of the cases reported in the medical literature were associated with left ventricular outflow tract obstruction. The majority of cases of accessory mitral valve tissue, causing left ventricular outflow tract obstruction, occur in association with other congenital cardiac anomalies. In this reported case, a patient with accessory mitral valve tissue complicated with thromboembolic cerebrovascular event is presented. The patient also had an associated idiopathic hypertrophic subaortic stenosis.

Increased Systemic and Regional Coagulation Activity in Patients with Mitral Stenosis and Sinus Rhythm

A hypercoagulable state has been reported in patients with mitral stenosis (MS) and sinus rhythm (SR). However it has been suggested that the coagulation activity may be increased only within the left atrium in MS, with normal peripheral blood levels. The aim of the present study was to assess regional left atrial and systemic coagulation activities by measuring PF 1 +2 in patients with severe mitral stenosis and sinus rhythm, normal blood clotting times, and no left atrial thrombus. The study was conducted in 25 consecutive patients with moderate-to-severe MS and sinus rhythm who underwent percutaneous balloon mitral valvu loplasty. Transesophageal echocardiography was performed before the valvuloplasty procedure in all patients to exclude the presence of left atrial thrombus and left atrial spontaneous echo contrast (LASEC). There were no statistically significant differences between LASEC-positive and LASEC-negative patients with respect to age, gender, fibrinogen levels, prothrombin time, mitral valve area, mean mitral gradient, pulmonary artery pressure (in all p> 0.05). Regional (left atrial) PF1+2 levels of both LASEC-positive and LASEC-negative patients were significantly elevated when compared to control subjects (p<0.01). Statistically significant elevated systemic level of PF 1 +2 was observed only in LASEC-positive patients when compared to control subjects (p<0.01, p>0.05, respectively). In conclusion patients with severe mitral stenosis and SR have increased regional coagulation activity in both LASEC-negative and LASEC-positive groups. Although this increased regional coagulation activity has been reflected in peripheral blood of LASEC-positive patients, it has not been reflected in peripheral blood of LASEC-negative patients.