Tak Kwan

Primary stent implantation compared with primary balloon angioplasty for acute myocardial infarction: a meta-analysis of randomized clinical trials

The clinical efficacy of primary angioplasty for acute myocardial infarction (AMI) is limited by recurrent myocardial ischemia during the hospital stay and restenosis in the months thereafter. 1 With the application of more effective poststenting antithrombotic regimens 2 and the improvement in stent implantation techniques, 3 coronary stenting is no longer considered contraindicated in thrombus-containing lesions and has gained substantial popularity in the setting of AMI. Recently, several randomized clinical trials have been conducted that compared coronary stenting and balloon angioplasty as the primary revascularization strategy for AMI. 4 ‐14 In the present study, we performed a meta-analysis of all the reported randomized trials to assess the overall comparative efficacy of these 2 strategies on major clinical outcomes in AMI.

Paravalvular Regurgitation: A Rare Complication Following Valve Replacement Surgery

Paravalvular regurgitation is an uncommon but important complication, usually following valve replacement surgery. Early recognition and management are important for reop erations are associated with high morbidity and mortality rates. Presently, little data are available on this topic. The authors review the subject.

Cardiac disease and nonorganic chest pain : factors leading to disability

Research has shown that many chest pain patients, without coronary artery disease, may suffer from panic disorder, hypochondriasis, depression, and/or multiple phobias. Some patients with coronary artery disease may also suffer from these disorders and are often unable to return to previous activity. In spite of good prognosis for longevity and acceptable exercise test results, a large proportion of these patients continue to be disabled by chest pain and/or chronic cardiac fears and demand constant medical attention. This study examined the psychiatric and behavioral symptomatology that differentiated four groups of patients experiencing chest pain: the able (active/working patient) with and without coronary artery disease, as determined by exercise thallium-201 studies, and the disabled (inactive/nonworking patient) with and without coronary artery disease. The results of the study indicated that the inactive patients, both with and without heart disease, suffered from a host of debilitating psychiatric conditions.

Anomalous origin of the left main coronary artery from the right sinus of Valsalva: disabling angina and syncope with noninterarterial courses case report of two patients.

Anomalous origin of the left main coronary artery from the right sinus of Valsalva or the right coronary artery is a rare coronary anomaly. This anomaly has been associated with sudden cardiac death in younger patients, depending on its course relative to the pulmonary artery. The authors report this rare anomaly in two patients. It presented as unstable angina in the first patient with a septal course. In the second patient, it presented as syncope with an anterior free wall course and absent left circumflex artery. A septal course causing unstable angina has not been reported previously.

No-reflow phenomenon following percutaneous coronary intervention: an uncommon complication.

The no-reflow phenomenon has been recognized as an uncommon complication after reperfusion therapy (thrombolytic or mechanical) for acute myocardial infarction and after percutaneous coronary intervention. As management and outcomes differ, early diagnosis and angiographic exclusion of other causes of impaired blood flow are important. The authors describe a case report of a patient with no-reflow following emergent stenting of the left circumflex artery (LCX). Pathophysiology and management of the no-reflow phenomenon are described along with the case report.

ST-T alternans and myocardial ischemia.

Previous studies using intracoronary electrocardiography have demonstrated that ST-T alternans can develop during standard balloon coronary angioplasty. Total occlusion with a large amount of myocardium in jeopardy is the postulated prerequisite. In this study, the authors used perfusion balloons instead of standard balloons, so coronary perfusion was maintained and ischemia was minimized. Fourteen patients with standard balloon technique and 11 patients with perfusion balloon technique were studied. The ST segment was less elevated during perfusion angioplasty (0.15 ±0.05 mV vs 1.04 ±0.19 mV, p<0.001). There were six (43%) patients with ST-T alternans with standard balloon technique compared with none in the perfusion balloon group (p<0.001) . In this study, the authors found that there was less ischemia, less ST segment elevation, and lack of ST-T alternans on the intracoronary electrocardiogram during perfusion balloon angioplasty. These findings support the postulate that a large amount of ischemic myocardium is a prerequisite for ST-T alternans.

Takayasu's Arteritis: An Unusual Manifestation: A Case Report

Takayasus arteritis is a rare entity. The authors describe a case of a middle-aged woman with an atypical form of Takayasus arteritis. This manifestation has not been described previously.

Coronary artery aneurysms, aortic dissection, and hypertension secondary to primary aldosteronism : A rare triad : A case report

Primary aldosteronism is a relatively uncommon etiology of hypertension. Plasma renin activity is suppressed in the majority of the cases but not always. Plasma renin activity has been associated with increased vascular injury. The occurrence of vascular complications has rarely been reported with low plasma renin activity. The authors report a case of long-standing secondary hypertension due to primary aldosteronism with coronary artery aneurysms and aortic dissection. Diagnosing is important, for therapeutic intervention can be curative.

Dynamic Left Ventricular Outflow Obstruction: A Reversible Mechanical Complication of Acute Myocardial Infarction A Case Report

Dynamic left ventricular outflow obstruction is a less well-known mechanical complication of acute myocardial infarction. Early diagnosis is important because initiation of proper manage ment and avoidance of precipitating factors can lead to complete recovery. A patient is described who presented with acute myocardial infarction and in whom significant left ventric ular outflow tract obstruction developed. Adequate therapy with β blockers and calcium channel blockers led to complete resolution of the obstruction.

Successful Transcatheter Closure of a Patent Ductus Arteriosus: Using Two Gianturco Coils in a 41-Year-Old Woman A Case Report

Patent ductus arteriosus (PDA) is a form of congenital heart disease uncommonly diagnosed in adult patients. Transcatheter closure of PDA has been widely used in children. However, the experience is limited in adults especially with use of Gianturco coils. The authors describe a case of successful transcatheter closure of a PDA, inciden tally diagnosed in a 41-year-old woman, by successively deploying two coils by a transar terial approach. No residual shunting was seen angiographically after the procedure. A literature review of similar procedures in adult patients is discussed.