Coronary fistulas are rare, not gender-specific congenital conditions, consisting of communications between the coronary arteries and either another coronary vessel or a cardiac chamber. In contrast to large fistulas, small fistulas, named “minimae cordis veneae” or the Thebesius venous system, are draining into heart chambers and form a vascular network in the cardiac lumen. In this article, we present the case of a 72-year-old female with a significant history of cardiovascular disease, admitted to our clinic because of rest dyspnea, fatigue, and minimal chest pain. The 12-lead electrocardiogram showed a trifascicular block (a second-degree atrioventricular block Mobitz II, associated with a right bundle branch block and left anterior fascicle block) and negative T waves in DII, DIII, aVF, V4–V6 leads. An invasive coronary angiography was performed, which revealed no significant atherosclerotic lesions. However, a persistent capillary blush was present at the apex site of the left ventricular chamber, draining from the distal segments of both the anterior descending coronary artery and the posterior interventricular coronary artery. The intramural vascular network generating a left ventricle angiogram image of this kind was suggestive for persistent Thebesian vessels connecting the two coronaries with the left ventricular chamber.
Despite of numerous treatment strategies developed in the last years, ischemic heart disease remains the leading cause of death around the world. Acute myocardial infarction (MI) causes irreversible destruction to the myocardial tissue, which is replaced by fibroblast cells, leading to the formation of a dense, collagenous scar, a non-contractile tissue, and often to heart failure. Stem cell therapy seems to represent the next therapeutic method for the treatment of heart failure caused by myocardial infarction. Several international trials proved the beneficial outcome of the intracoronary infusion of bone marrow-derived stem cells, improving left ventricular systolic function and clinical symptomatology. Many noninvasive imaging procedures are available to evaluate the beneficial properties of stem cell therapy. Most studies have demonstrated the role of multislice computed tomography (MSCT) in evaluating left ventricular parameters such as end-diastolic and end-systolic volumes and ejection fraction, or to quantify myocardial scar tissue. In this review we will discuss the usefulness of MSCT for the assessment of coronary arteries, new tissue regeneration, and evaluation of tissue changes and their functional consequences in subjects undergoing stem cell treatment following MI.
Background: Atrial fibrillation (AF), a common arrhythmia in clinical practice, is associated with a high rate of complications and an increased risk for thromboembolic events. Pulmonary vein ablation is a new therapeutic option to cure AF; however, it remains associated with a high rate of recurrence. In this study we aimed to identify the clinical characteristics and imaging-based features that may predict the risk of recurrence after pulmonary veins ablation in atrial fibrillation.
Materials and method: Twenty-four patients with paroxysmal and persistent AF, who underwent radiofrequency catheter ablation and a 12-month follow-up were included in the study. Group 1 included 8 patients with AF recurrence, and group 2 included 16 patients with no AF recurrence. In all cases, cardiovascular risk factors, ejection fraction, left atrial diameter, atrial volumes, and epicardial fat volume were analyzed.
Results: CT analysis revealed that patients with AF recurrence presented a significantly larger mean index of left atrial volume (59.57 ± 8.52 mL/m2 vs. 49.99 ± 10.88 mL/m2, p = 0.04), right atrial volume (58.94 ± 8.37 mL/m2 vs. 43.21 ± 6.4 mL/m2, p<0.0001), and indexed bi-atrial volume (118.5 ± 15.82 mL/m2 vs. 93.19 ± 16.42 mL/m2, p = 0.005). At the same time, CT analysis of the epicardial adipose tissue volume indicated that patients with AF recurrence have a larger amount of epicardial fat than those without AF recurrence (176.4 ± 100.8 mL vs. 109.8 ± 40.73 mL, p = 0.02).
Conclusion: Left atrial diameter, indexed atrial volumes, and epicardial fat volume may be used as factors to identify patients at risk for developing recurrence after pulmonary vein ablation.
Usually, the diagnosis of myocardial infarction based on patient symptoms, electrocardiogram (ECG) changes, and cardiac enzymes, is not a challenge for cardiologists. The correlation between coronary anatomy and the ECG territories that present ischemic changes can help the clinician to estimate which coronary artery presents lesions upon performing a coronary angiogram. In certain situations, the diagnosis of myocardial infarction can be difficult due to the lack of correlations between the clinical and paraclinical examinations and the coronary angiogram. In some cases, patients with chest pain and ST-segment elevation on the ECG tracing present with a normal coronary angiography. In other cases, patients without important changes on the ECG can present critical lesions or even occlusions upon angiographic examination. The aim of this article is to highlight the role of noninvasive coronary magnetic resonance and multi-slice computed tomography in patients with ST-segment elevation myocardial infarction and normal coronary angiography.
Given the higher amount of detail it offers, the use of magnetic resonance (MR) in the field of cardiology has increased, thus leading to a decrease in the use of invasive and irradiating methods for diagnosing various cardiovascular disorders. The only precautions for MR imaging are metallic implants and advanced-stage chronic kidney disease. For the acquisition of clear and dynamic myocardial images, methods such as spin echo imaging for anatomical description, steady-state free precession imaging for the assessment of ventricular cavity size and function, flow velocity encoding for blood flow measurements, radiofrequency tagging for dynamics, and even spectroscopy for metabolism evaluation are used. Cardiac magnetic resonance (CMR) is considered the gold standard imaging method for the anatomical characterization of the heart and obtaining information related to myocardial dynamics. In case of ischemic events, CMR is used for a detailed description of the necrotic area and the complications, and for tracking the ventricular remodeling. By administrating a contrast agent (gadolinium), the difference between sub-endothelial and transmural infarctions can be distinguished, highlighting even microvascular lesions responsible for the extension of the necrosis. The assessment of the dynamics of ventricular remodeling and viability through late gadolinium enhancement (LGE) technology highlights the area of fibrosis and the occurrence of late complications.
For a better assessment of ischemic heart diseases, myocardial viability should be quantified. Current studies underline the importance and the evolution of several techniques and methods used in the evaluation of myocardial viability. Taking into account these considerations, the aim of this manuscript was to present the recent points of view regarding myocardial viability and its clinical significance in patients with ischemic cardiomyopathies and left ventricular dysfunction. On the other hand, the manuscript points out the role of magnetic resonance imaging (MRI), one of the most useful noninvasive imaging techniques, in the assessment of myocardial viability. By comparing the advantages and disadvantages of cardiac MRI, its usefulness can be better appreciated by the clinician. In the following years, it is considered that MRI will be an indispensable imaging tool in the assessment of ischemic heart disease, guiding interventions for revascularization and long-term risk stratification in patients with stable angina or myocardial infarction.
Coronary artery malformations are rare congenital abnormalities, which present non-specific symptoms such as atypical chest pain, malignant arrhythmia, or sudden cardiac death. The proper diagnosis of these abnormalities in emergency conditions can be very difficult, and noninvasive imaging techniques, such as computed tomography or magnetic resonance imaging, along with the gold standard represented by invasive coronary angiography, remain the most frequently used modalities for diagnosing these rare cases. We present four cases of coronary anomalies represented by an abnormal origin of the coronary arteries from the coronary ostium, presenting in emergency conditions with symptoms of acute myocardial infarction, which were diagnosed by urgent angiography.
Patients who suffer from diabetes mellitus and present coronary artery disease are at a higher risk of cardiovascular events. The coronary arteries of diabetic patients present a diffuse process of atherosclerosis with frequent distal involvement, being prone to acute cardiovascular events. Diabetics present an increased rate of developing coronary artery remodeling, negative remodeling being representative for this class of patients; this process is characterized by vessel shrinkage and an increased rate of coronary calcium accumulation that is a predictor for cardiovascular risk. Currently, it is desired to improve the treatment of diabetic patients with bioresorbable vascular scaffolds (BVS), because of their reduced risk of restenosis and the ability to restore coronary function, including vasomotion, adaptive shear stress, and expansive remodeling. Optical coherence tomography, intravascular ultrasound and multi-slice computed tomography are imaging techniques used for a high accuracy of diagnosis in coronary artery disease. This manuscript is a review that aims to highlight imaging techniques used for evaluating the functional impact of coronary lesions in diabetic patients who underwent coronary PCI with bioresorbable scaffolds and to describe the functional markers that show the specificity for predicting coronary artery disease.
Introduction: Myocardial involvement in pericardial diseases and the effect of pericardial inflammation and effusion on the function of the left ventricle (LV) is still a controversial issue. The present study aimed to evaluate LV regional wall abnormalities in patients with acute peri-myocarditis, using 3D echocardiographic assessment of LV contractility. Material and methods: The study included 56 subjects divided into two groups: Group 1 - 28 subjects with acute peri-myocarditis and Group 2 - 28 healthy controls. All subjects underwent a complete clinical examination, including laboratory tests. 3D echocardiography was performed to assess the left ventricular end-diastolic (EDV) and end-systolic volumes (ESV), and to calculate specific indexes for global and regional ventricular contractility, such as the index of contraction amplitude (ICA) and the regional index of contraction amplitude (RICA) for each segment corresponding to the region affected by peri- myocarditis. Results: 3D echocardiography showed no differences between the groups regarding the EDV (p = 0.2), the LV ejection fraction (Group 1: 55.82% ± 3.36% vs. Group 2: 57.21% ± 4.69%, p = 0.2). The ESV however, was significantly higher in Group 1 compared to Group 2 (55.78 ± 5.45 ml vs. 52.20 ± 6.43 ml, p = 0.04). ICA was similar between the groups (p = 0.2). However, the RICA was significantly lower in Group 1 compared to Group 2 (2.27 ± 0.63 vs. 5.16 ± 0.54, p <0.0001). Conclusions: The extension of the inflammatory process from the pericardium to the adjacent myocardial layer may affect the contractility of the LV. A good association exists between peri-myocarditis and the regional contractility abnormalities of the LV.
Atrial fibrillation (AF) is the most frequent form of supraventricular arrhythmia in medical practice. It is characterized by chaotic electrical activity in the atria, which often leads to irregular and fast ventricular contractions. Pulmonary veins (PV) play an essential part in the genesis of AF. There are a series of risk factors that trigger the development and recurrence of AF after PV isolation. Despite advanced medical technology, the success rate of AF ablation is not satisfactory. The purpose of this study is to assess the preprocedural imaging and serum biomarkers linked to an increased recurrence of AF after PV isolation. The primary endpoint is represented by AF recurrence after PV isolation. In addition, the rate of cardiovascular death and the rate of major adverse cardiovascular events will be assessed in relation to the enlargement of the left atrium and the volume of epicardial adipose tissue surrounding the heart.