A Case of Multiple Coronary Artery-Left Ventricular Microfistulae Demonstrated by Transthoracic Doppler Echocardiography
Seong Hun ChoiHye–Sun SeoSung Jin OhGeu‐Ru HongSeok‐Min KangMoon‐Hyoung LeeSe‐Joong RimYangsoo JangNamsik ChungSeung Yun Cho
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Of the congenital coronary artery fistulae, the multiple coronary artery microfistulae, arising from the left and right coronary artery emptying into the left ventricle, are very rare. Little is known about their anatomic and clinical features, especially in apical hypertrophic cardiomyopathy. The clinical findings are heterogeneous, but include, in most cases, a history of typical or atypical angina pectoris. A 67 year old woman was referred for evaluation of chest pain on exertion, and a shortness of breath. The electrocardiographic and echocardiographic findings were typical of apical hypertrophic cardiomyopathy. Coronary arteriography showed normal epicardial coronary arteries, but multiple coronary artery-left ventricular microfistulae arising from the left and right coronary arteries. Transthoracic Doppler echocardiography, using a high frequency transducer, with a low Nyquist limit, demonstrated multiple coronary artery-left ventricular microfistulae just beneath the apical impulse window. (Korean Circulation J 2003;33 (4):338-342)Keywords:
Left coronary artery
ABSTRACT. Continuous wave Doppler echocardiography was used to estimate pressure gradients in 27 children with right or left ventricular outflow tract obstruction. Tbe pressure gradients predicted by Doppler were compared to peak‐to‐peak and instantaneous gradients measured at cardiac catheterization, When the Doppler study was performed the pressure gradient obtained at catheterization was not known to the examiner. A correlation coeffiaent of 0.76 was found for the comparison between the Doppler predicted gradient and the peak‐to‐peak gradient and 0.78 for the comparison with the instantaneous pressure gradient. Clinically significant obstructions could be reliably separated from insignificant obstructions by the Doppler technique.
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Left coronary artery
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Surgical repair of a 29-year-old woman's left coronary artery with an anomalous origin from the pulmonary artery was performed by reimplantation of the left main artery into the aorta, together with coronary artery bypass grafting. Subsequent stenosis of the reimplanted left main artery was treated with successful Palmaz-Schatz stent placement. Cathet. Cardiovasc. Diagn. 42:48–50, 1997. © 1997 Wiley-Liss, Inc.
Left coronary artery
Left pulmonary artery
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A A A A AA A A A A A A A A AA A A A A A A A A A A A AA A A A A A A A A A A A A A A A A A A A AA A A A A A A A A A A A A A A A A A AA A A A A A A A A A A A A A A A A A A A A A A A A A A A AA A A A A A A A A A A A A A A A A A A A A A A A AA A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A AA A A A A A A A A A A A A A A A A A A A A A A A A A A A A A AA A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A
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Transmitral flow velocity profiles by Doppler echocardiography are strongly related to left ventricular diastolic properties. The aim of this study was to address the assessment of left ventricular filling pressures by transmitral flow velocity curves in patients with impaired systolic function. 90 patients (23 female, 67 men, age 60.0 +/- 9,9 a) with an ejection fraction < or = 45% either due to coronary artery disease (n = 67) or dilated cardiomyopathy (n = 23) were investigated by Doppler echocardiography prior to left heart catheterization. Early diastolic deceleration time (DT) and ratio of early to late diastolic peak velocities (VE/VA) were measured. Both, DT and VE/VA showed a significant correlation to left ventricular enddiastolic pressures (r = -0.79 respectively r = 0.73, p < 0.001 for all). According to DT three different transmitral flow patterns were identified. All patients with restrictive filling patterns (DT < 160) had elevated left ventricular filling pressures, whereas impaired relaxation (DT > 210) was a strong predictor of normal filling pressures. In patients with pseudonormal transmitral flow patterns (DT 160 to 210) filling pressures could not be predicted. Furthermore DT was strongly related to clinical signs of left heart failure. Doppler echocardiography gives useful additional information on left ventricular filling pressures in patients with systolic dysfunction.
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Abstract Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) syndrome is a rare congenital coronary artery anomaly especially when diagnosed in an adult patient and remains an important cause of sudden cardiac death. We report a 46-year-old patient with ALCAPA syndrome managed with left main coronary artery (LMCA) interruption and grafting of the LMCA with left internal mammary artery so as to restore antegrade coronary flow. This approach of restoring dual-coronary-artery system by grafting the LMCA allows antegrade blood flow as in a normal coronary artery to a large area of viable myocardium, is more physiological, and is practical and easy to accomplish in an anteriorly placed and dilated LMCA as seen in our case. (J Card Surg 2012;27:325–327)
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Fifty-five consecutive adult patients with mitral stenosis (MS) were in vestigatedby Doppler echocardiography, to assess the severity of MS. The measurement of mitral valve area (MVA) by cross-sectional echocardiography (CSE) was considered as the reference method, because catheterization data are often inadequate when combined lesions are present. Doppler MVA was calculated from apical mitral flow using the pressure half-time method. Adequate Doppler recordings (52 on 55) were easier to obtain than adequate CSE images[47]. The correlation between both methods was excellent (r = 0.90, SEE: 0.42 cm2) despite systematic underestimation of MVA by Doppler versus CSE. From our data, the following regression equation could be drawn, providing MVA from Doppler measurements: MVA = 250 (pressure half-time)−1 +0.15, where the area is in cm1 and half-time in ms. Both severe and mild MS were identified by Doppler with enough accuracy for clinical use. Reproducibility, inter and intraobserver variability were better for Doppler than for CSE. We conclude that Doppler seems particularly suitable for noninvasive quantification of MS and for patient follow-up.
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