768 3. Davis JA, Cecchin F, Jones TK, Portman MA. Major coronary artery anomalies in a pediatric population: incidence and clinical importance. J Am Coll Cardiol 2001;37: 593 –7. 4. Angelini P, Villason S, Chan AV, Diez JG. Normal and anomalous coronary arteries in humans. In: Angelini P, ed. Coronary Artery Anomalies: A Comprehensive Approach. Philadelphia: Lippincott Williams & Wilkins; 1999. pp. 27 –150. 5. Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA et al. ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2008;52:143–263. 6. Angelini P. Coronary artery anomalies: an entity in search of an identity. Circulation 2007;115:1296 – 305. 7. Zeppilli P, Dello Russo A, Santini C, Palmieri V, Natale L, Giordano A et al. In vivo detection of coronary artery anomalies in asymptomatic athletes by echocardiographic screening. Chest 1998;114:89–93. 8. Pelliccia A, Spataro A, Maron BJ. Prospective echocardiographic screening for coronary artery anomalies in 1,360 elite competitive athletes. Am J Cardiol 1993;72:978–9. 9. Frommelt PC, Frommelt MA, Tweddell JS, Jaquiss RD. Prospective echocardiographic diagnosis and surgical repair of anomalous origin of a coronary artery from the opposite sinus with an interarterial course. J Am Coll Cardiol 2003;42: 148 –54. 10. Ghersin E, Litmanovich D, Ofer A, Lessick J, Dragu R, Rispler S et al. Anomalous origin of right coronary artery: diagnosis and dynamic evaluation with multidetector computed tomography. J Comput Assist Tomogr 2004;28:293 – 4. 11. McConnell MV, Ganz P, Selwyn AP, Li W, Edelman RR, Manning WJ. Identification of anomalous coronary arteries and their anatomic course by magnetic resonance coronary angiography. Circulation 1995;92:3158 –62.
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12. Hejmadi A, Sahn DJ. What is the most effective method of detecting anomalous coronary origin in symptomatic patients? J Am Coll Cardiol 2003;42:155–7. 13. Basso C, Maron BJ, Corrado D, Thiene G. Clinical profile of congenital coronary artery anomalies with origin from the wrong aortic sinus leading to sudden death in young competitive athletes. J Am Coll Cardiol 2000;35:1493 –501. 14. Angelini P, Velasco JA, Ott D, Khoshnevis GR. Anomalous coronary artery arising from the opposite sinus: descriptive features and pathophysiologic mechanisms, as documented by intravascular ultrasonography. J Invasive Cardiol 2003;15:507 – 14. 15. Brothers JA, Stephens P, Gaynor JW, Lorber R, Vricella LA, Paridon SM. Anomalous aortic origin of a coronary artery with an interarterial course: should family screening be routine? J Am Coll Cardiol 2008;51:2062 –4. 16. Gersony WM. Management of anomalous coronary artery from the contralateral coronary sinus. J Am Coll Cardiol 2007;21:2083 –4. 17. DiLello F, Mnuk JF, Flemma RJ, Mullen DC. Successful coronary reimplantation for anomalous origin of the right coronary artery from the left sinus of Valsalva. J Thorac Cardiovasc Surg 1991;102:455 – 6. 18. Romp RL, Herlong JR, Landolfo CK, Sanders SP, Miller CE, Unqerleider RM et al. Outcome of unroofing procedure for repair of anomalous aortic origin of left or right coronary artery. Ann Thorac Surg 2003;76:589 – 95. 19. Taylor AJ, Rogan KM, Virmani R. Sudden cardiac death associated with congenital coronary artery anomalies. J Am Coll Cardiol 1992;20:640 –7. 20. Raanani E, Kogan A, Shapira Y, Sagie A, Kornowsky R, Vidne BA. Surgical reconstruction of the left main coronary artery: fresh autologous pericardium or saphenous vein patch. Ann Thorac Surg 2004;78:1610 –3. 21. Aubry P, Joudinaud T, Hyafil F. Anomalous origin of coronary arteries in adults. Ann Cardiol Angeiol (Paris) 2008;57:327 –34.
doi:10.1093/ehjci/jeu007 Online publish-ahead-of-print 4 February 2014
.............................................................................................................................................................................
Transient left ventricular outflow tract obstruction in a patient with ruptured dissecting aortic aneurysm Ai Kawamura, Hiroyuki Okura*, and Kiyoshi Yoshida Division of Cardiology, Kawasaki Medical School, Kurashiki, Japan
* Corresponding author. Tel: +81 86 462 1111; Fax: +81 86 462 1199, Email: [email protected]
A 86 year-old woman was admitted to our hospital because of chest pain. An emergent computed tomography revealed ruptured dissecting aortic aneurysm of the descending aorta (Panel A). On admission, she was hypotensive (blood pressure 74/40 mmHg) and jugular venous dilatation and pretibial edema were noted. Echocardiography (Panels B, C and see Supplementary data online, Movie S1) showed that the left atrium was compressed by the mediastinal haematoma and systolic anterior motion (SAM) of the anterior mitral leaflet was observed (Panels C and D; arrow). Colour and continuous wave Doppler echocardoiography revealed left ventricular outflow tract (LVOT) stenosis with a maximal pressure gradient of 128 mmHg (Panels E and F ). Because of high operative risk, she was conservatively managed using a beta-blocker. The size of haematoma gradually decreased and SAM/LVOT stenosis disappeared and she was discharged 3 months after admission. In this case, a combination of acute blood loss, decreased left atrial and ventricular chamber size due to compression, and increased sympathetic activity was considered as possible cause of SAM and LVOT stenosis. Supplementary data are available at European Heart Journal – Cardiovascular Imaging online. Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2014. For permissions please email: [email protected]
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F. Labombarda et al.
12. Hejmadi A, Sahn DJ. What is the most effective method of detecting anomalous coronary origin in symptomatic patients? J Am Coll Cardiol 2003;42:155–7. 13. Basso C, Maron BJ, Corrado D, Thiene G. Clinical profile of congenital coronary artery anomalies with origin from the wrong aortic sinus leading to sudden death in young competitive athletes. J Am Coll Cardiol 2000;35:1493 –501. 14. Angelini P, Velasco JA, Ott D, Khoshnevis GR. Anomalous coronary artery arising from the opposite sinus: descriptive features and pathophysiologic mechanisms, as documented by intravascular ultrasonography. J Invasive Cardiol 2003;15:507 – 14. 15. Brothers JA, Stephens P, Gaynor JW, Lorber R, Vricella LA, Paridon SM. Anomalous aortic origin of a coronary artery with an interarterial course: should family screening be routine? J Am Coll Cardiol 2008;51:2062 –4. 16. Gersony WM. Management of anomalous coronary artery from the contralateral coronary sinus. J Am Coll Cardiol 2007;21:2083 –4. 17. DiLello F, Mnuk JF, Flemma RJ, Mullen DC. Successful coronary reimplantation for anomalous origin of the right coronary artery from the left sinus of Valsalva. J Thorac Cardiovasc Surg 1991;102:455 – 6. 18. Romp RL, Herlong JR, Landolfo CK, Sanders SP, Miller CE, Unqerleider RM et al. Outcome of unroofing procedure for repair of anomalous aortic origin of left or right coronary artery. Ann Thorac Surg 2003;76:589 – 95. 19. Taylor AJ, Rogan KM, Virmani R. Sudden cardiac death associated with congenital coronary artery anomalies. J Am Coll Cardiol 1992;20:640 –7. 20. Raanani E, Kogan A, Shapira Y, Sagie A, Kornowsky R, Vidne BA. Surgical reconstruction of the left main coronary artery: fresh autologous pericardium or saphenous vein patch. Ann Thorac Surg 2004;78:1610 –3. 21. Aubry P, Joudinaud T, Hyafil F. Anomalous origin of coronary arteries in adults. Ann Cardiol Angeiol (Paris) 2008;57:327 –34.
doi:10.1093/ehjci/jeu007 Online publish-ahead-of-print 4 February 2014
.............................................................................................................................................................................
Transient left ventricular outflow tract obstruction in a patient with ruptured dissecting aortic aneurysm Ai Kawamura, Hiroyuki Okura*, and Kiyoshi Yoshida Division of Cardiology, Kawasaki Medical School, Kurashiki, Japan
* Corresponding author. Tel: +81 86 462 1111; Fax: +81 86 462 1199, Email: [email protected]
A 86 year-old woman was admitted to our hospital because of chest pain. An emergent computed tomography revealed ruptured dissecting aortic aneurysm of the descending aorta (Panel A). On admission, she was hypotensive (blood pressure 74/40 mmHg) and jugular venous dilatation and pretibial edema were noted. Echocardiography (Panels B, C and see Supplementary data online, Movie S1) showed that the left atrium was compressed by the mediastinal haematoma and systolic anterior motion (SAM) of the anterior mitral leaflet was observed (Panels C and D; arrow). Colour and continuous wave Doppler echocardoiography revealed left ventricular outflow tract (LVOT) stenosis with a maximal pressure gradient of 128 mmHg (Panels E and F ). Because of high operative risk, she was conservatively managed using a beta-blocker. The size of haematoma gradually decreased and SAM/LVOT stenosis disappeared and she was discharged 3 months after admission. In this case, a combination of acute blood loss, decreased left atrial and ventricular chamber size due to compression, and increased sympathetic activity was considered as possible cause of SAM and LVOT stenosis. Supplementary data are available at European Heart Journal – Cardiovascular Imaging online. Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2014. For permissions please email: [email protected]
Downloaded from by guest on November 14, 2015
IMAGE FOCUS
