Pairoj Rerkpattanapipat

Meta-Analysis of 143 Reported Cases of Aortic Intramural Hematoma

Aortic intramural hematoma (IMH) is a clinical condition that has still not been completely defined. We conducted a meta-analysis of reported cases and analyzed the demographic profiles, imaging modalities, pathologic sites, and treatment strategies in relation to outcome in 143 patients with IMH. We performed an English language search of Medline for manuscripts with the keywords aortic diseases, aorta AND hematoma, and intramural hematoma. Data from 143 reported cases were extracted. IMH of the aorta has a reported incidence of 5% to 20% among patients with acute aortic syndromes and a mortality rate of 21%. Most patients were men (61%) and median age was 68 years (range 15 to 88). Hypertension was a predisposing factor in 53% of the patients. Most patients had chest and/or back pain (80%). Transesophageal echocardiography, computer tomographic scan, or magnetic resonance imaging may be effectively used to diagnose this condition. There is no difference in the overall mortality rates in Stanford type A versus type B patients. Patients with Stanford type A IMH who underwent surgery, compared with those who underwent medical management, had a significantly better prognosis (14% vs 36% mortality, respectively, p < 0.02). Patients in Stanford group A who received medical treatment had a higher mortality rate than those in group B who received medical treatment (36% vs 14% mortality respectively, p < 0.02). In type B patients, medical and surgical outcomes were similar.

Relation of aortic distensibility determined by magnetic resonance imaging in patients ≥60 years of age to systolic heart failure and exercise capacity

Aortic stiffness increases with advancing age and is associated with the age-related decline in exercise capacity in healthy persons. Previous studies have suggested that aortic compliance is reduced in heart failure (HF). Older persons with systolic HF can have particularly severe exercise intolerance. However, the relation between increased aortic stiffness and exercise intolerance in elderly patients with systolic HF has not been examined. Therefore, aortic distensibility of the proximal ascending aorta (assessed by magnetic resonance imaging) and exercise tolerance (assessed by maximal exercise ergometry with expired gas analysis) was measured in 28 subjects (10 healthy subjects aged 20 to 30 years, 10 healthy subjects aged > or =60 years, and 8 subjects aged > or =60 years with systolic HF). Compared with healthy older subjects, patients with systolic HF had markedly decreased distensibility of the proximal aorta (0.5 +/- 0.4 vs 2.2 +/- 1.2 10(-3) mm Hg(-1), p <0.002), decreased peak exercise volume of oxygen consumption (VO2) (858 +/- 248 vs 1,436 +/- 344 ml/min, p <0.001), and increased aortic wall thickness (3.6 +/- 0.7 vs 2.9 +/- 0.4 mm, p <0.04). Aortic distensibility was significantly correlated with peak VO2 (r = 0.80, p <0.0001) and remained so even after being adjusted for age and left ventricular (LV) ejection fraction. These data suggest that decreased aortic distensibility may contribute to exercise intolerance in older patients with HF due to LV systolic dysfunction.

Use of stents to treat kinks causing obstruction in a left internal mammary artery graft.

Left internal mammary arteries (LIMA) are used routinely as grafts to the left anterior descending coronary artery (LAD) in selected patients undergoing coronary artery bypass graft (CABG) surgery because of better long‐term patency rates. Pathology other than fibrointimal hyperplasia, accelerated atherosclerosis, or thrombus can sometimes cause obstructive lesions in such grafts. This report illustrates a kink in a LIMA graft to the LAD causing an obstructive lesion shortly after surgery and describes the subsequent management of this lesion with intracoronary stents. Cathet. Cardiovasc. Intervent. 46:223–226, 1999.

Rapid Dissolution of Massive Intracoronary Thrombosis With Platelet Glycoprotein IIb/IIIa Receptor Inhibitor

This 56-year-old man presented with unstable angina and acute pulmonary edema. He underwent cardiac catheterization, which revealed extensive thrombotic occlusion of the mid left anterior descending coronary artery (LAD), the second diagonal branch, and the second septal perforating branch (Figure 1⇓). Recanalization of the mid-LAD with …

Dobutamine Stress Magnetic Resonance Imaging

Measurements of left ventricular function with cardiovascular magnetic resonance (CMR) at rest and during intravenous dobutamine are useful for identifying myocardial ischemia, viability, and the risk of subsequent cardiovascular events. Without ionizing radiation, intravascular iodinated contrast administration, or acoustic window limitations, CMR has emerged as a useful adjunct to transthoracic echocardiography for assessing patients with or suspected of having coronary artery disease.

Dynamic Left Ventricular Outflow Tract Obstruction Complicating Acute Myocardial Infarction

Dynamic left ventricular outx8fow tract (LVOT) obstruction has been associated with hypertrophic obstructive cardiomyopathy. Acute dynamic LVOT obstruction has been described as a complication of myocardial infarction.1,2 In the latter situation, this unusual form of outx8fow tract obstruction occurs as a result of compensated hyperdynamic basal wall motion in patients with apical infarction. We describe a patient who developed LVOT obstruction following percutaneous coronary intervention after suffering a diagonal occlusion and myocardial infarction.