Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

After an extensive analysis of the world literature (121 references), beginning from the first reported case by Antopol and Kugel, 1933, the general review of the problem stressed especially the following morphologic characteristics and clinical significance of the anomalous origin of the left circumflex coronary artery (LCxA) from the right coronary artery (RCA): The place of the anomalous origin of LCxA from RCA among all other variations and anomalies of LCxA. The anatomical and topographical characteristics of LCxA originating from RCA in normal heart as well as in congenital heart diseases--CHD (especially complete transposition of great arteries--TGA). The formal genesis of LCxA from RCA according to original new Ogden's theory, taking into account the dual origin of the coronary arteries and the peritruncal angioblastic ring that surrounds the developing aorta and pulmonary artery. The frequencies of the origin of LCxA from RCA in autopsy and coronarography series. The importance of LCxA (by its origin and/or caliber) in determination of the right, left or codominance of the coronary arteries including the peculiarities in cases of isolated aortic stenosis and bicuspid aortic valve. The importance of recognizing LCxA from the RCA during implantation of artificial aortic, mitral and tricuspid heart valves, during mitral valve anuloplasty, closure of ostium primum defect as well as during aorto-coronary venous bypass. The LCxA from RCA, especially its proximal segment, shows more frequent and an earlier, faster and heavier obstructive atherosclerosis, causing different manifestations of coronary heart disease and sudden death. Also, mitral insufficiency can be caused by ischemia of the papillary muscles of the left ventricle. The awareness of the possibility that LCxA may arise from the RCA can prevent many complications during cannulations of the coronary arteries for diagnostic coronarography and myocardial perfusion during heart operations. The authors presented their 30 autopsied cases of LCxA from RCA, analysing morphological and topographic data as well as their clinical significance and association with other CHD. There were 6 isolated cases and 24 cases associated with other CHD (20 with TGA and 4 with other CHD). Our first autopsied case of LCxA from RCA was diagnosed as associated with tetralogy of Fallot in 1964. During the period 1964-1985 we had 1015 cases of CHD (including 132 cases of TGA).(ABSTRACT TRUNCATED AT 400 WORDS)
 ...
PMID:[Pathologic morphology and clinical significance of the anomalous origin of the left circumflex coronary artery from the right coronary artery. General review and autopsy analysis of 30 cases]. 213 27

Clinical studies of patients with aortic stenosis suggest that left ventricular myocardial injury is frequent. To examine the morphologic basis of this observation, we studied 32 patients with isolated aortic stenosis, no cardiac surgery, and hearts studied at autopsy after postmortem arteriography and fixation in distension. The patients were 46-87 years old (average 69), and 21 (66%) were male. Calcific aortic stenosis was present in 19 hearts, 12 had congenital bicuspid aortic valve, and 1 had rheumatic aortic stenosis. In 19 hearts there was moderate or marked coronary atherosclerosis, and 12 hearts had 17 myocardial infarcts. However, among 13 hearts with no or mild coronary atherosclerosis, 9 had either subendocardial myocardial contraction band necrosis, a lesion occurring when periods of no perfusion are followed by reflow, or focal replacement fibrosis. In 13 hearts there was subendocardial vacuolization of myocytes, an alteration produced by ischemia, that was not accounted for by coronary artery disease. Our results are consistent with clinical observations and show that ischemic myocardial injury may be associated with isolated aortic stenosis in the absence of coronary artery obstruction. The contraction band necrosis and vacuolated myocytes suggest that both episodic and sustained reductions of subendocardial blood flow occur in the presence of aortic stenosis.
 ...
PMID:Myocardial injury in patients with aortic stenosis. 345 33

Coronary complications after aortic root replacement (ARR) with pulmonary autografts have been reported to be more common than with other stentless biological conduits (homografts, xenografts). To verify this hypothesis, results with 84 consecutive patients having stentless ARR between January 1992 and January 1999 were reviewed. Fifty patients had autograft (Group 1) and 34 either homograft or xenograft (Group 2) ARR. Comparison of age (27+/-9 vs. 38+/-22 years, P = ns), prevalence of male sex (86% vs. 79%, P = ns), aortic root disease (30% vs. 44%, P = ns), congenital coronary anomalies (10% vs. 3%, P = ns), prior aortic procedure (16% vs. 15%), and need for associated procedures (26% vs. 24%, P = ns), did not disclose significant differences. Bicuspid aortic valve was more prevalent in Group 1 (56% vs. 9%, P = .001). Mean aortic crossclamp (154+/-28 vs. 120+/-24 minutes, P = .05) and bypass (216+/-30 vs. 192+/-58 minutes, P = .05) times were longer in Group 1. Early mortality was comparable (2% vs. 3%, P = ns) and caused by right ventricular ischemia in both groups. Overall prevalence of coronary complications was higher in Group 1 (10% vs. 3%, P = .04), all resulting in right heart ischemia. Intraoperative partial takedown of repair in 5 Group 1 patients, associated with CABG in 1, resulted in prompt resolution of myocardial ischemia in 4 (80%) and prolonged in 1, which ultimately died as a result of sepsis. Recovery was prompt in all 4 patients (mean ICU stay 35+/-28 hours) with no metabolic or echocardiographic evidence of myocardial infarction. At discharge echocardiography, satisfactory biventricular kinetics was found in all patients. Analysis of preoperative variables showed bicuspid aortic valve (83% vs. 33%, P = .01) and coronary anomalies (67% vs. 3%, P = .001) to be more prevalent in patients suffering from coronary complications. Stentless ARR is a safe procedure with low operative mortality, regardless of the type of biological conduit. Autograft ARR may be at greater risk of right ventricular ischemia in patients with bicuspid aortic valve and coronary anomalies. An aggressive intraoperative approach including partial takedown of repair may limit the morbidity of coronary complications.
 ...
PMID:Risk factors for coronary complications after stentless aortic root replacement. 1066 Jan 80

Aortic stenosis in the elderly is related to calcification of either a bicuspid valve or a morphologically normal tricuspid valve. There is increasing evidence that factors relating to atherosclerosis are involved in valvular calcification and that it is an actively regulated process rather than a degenerative one. With severe aortic stenosis left ventricular hypertrophy occurs, decreasing wall stress and supporting the left ventricular ejection fraction. However, with pathologic hypertrophy there is a dropout of myocardial cells, subendocardial ischemia, and fibrosis. Eventually, symptoms of angina, non-Q wave myocardial infarction, exertional syncope, and heart failure occur. Once symptoms begin, the prognosis is poor, with sudden death occurring in about one third of patients who die. In the elderly, symptoms can be recognized very late in the course of the disease since they can be attributed to other problems and since the elderly patient may have reduced physical activity to a minimum. The more comorbidities that exist, the greater the risk of valve replacement. Symptomatic patients with severe aortic stenosis even over age 80 can be operated upon with a relatively low mortality and morbidity. In patients over age 80, prolongation of life for any meaningful length of time is not as important as relief of symptoms and improvement in the quality of life. Thus, it is unlikely that any truly asymptomatic patient over age 80, even with severe aortic stenosis, should be sent to surgery.
 ...
PMID:Pathophysiology of valvular aortic stenosis in the elderly. 1273 12

Aortic valve calcification is common in the elderly and in patients with congenital bicuspid aortic valve but unlike calcific mitral valve disease it is not a well recognized risk factor for stroke. Although autopsy studies have revealed evidence of systemic embolism in one-third of cases with calcific aortic valves, there is conflicting data from larger clinical studies examining the association between calcific aortic valve and stroke. There are only 8 reported cases of symptomatic stroke from spontaneous cerebral thromboembolism associated with calcific aortic valve in the literature. Computerized tomography (CT) angiography and CT without contrast are modalities of choice to diagnose calcific embolism, while MRI may be useful in delineating the extent of ischemia. Ideal management strategy, the role of antiplatelet therapy, anticoagulation or recommendations for valve replacements are poorly defined. We present a focused literature review on this topic.
 ...
PMID:Calcific aortic valve and spontaneous embolic stroke: a review of literature. 1971 38

Isolated spontaneous dissection of celiac trunk is a rare entity. The spontaneous dissection of the visceral artery occurs without aortic dissection. The most consistent presenting symptom is acute onset abdominal pain. Complications consist of ischemia, aneurysm formation, and rupture. We report an exceptional case of an isolated spontaneous dissection of the celiac trunk which occurred in a 49 year old male with a previously undiagnosed bicuspid aortic valve (BAV). We also describe the classical appearance in different imaging modalities with a particular emphasis on multidetector computed tomography, and discuss the clinical manifestation and its relationship to BAV.
 ...
PMID:Isolated spontaneous dissection of the celiac trunk in a patient with bicuspid aortic valve. 2053 40

Although bicuspid aortic valve occurs in an estimated 1% of adults and mitral valve prolapse in an estimated 5% of adults, occurrence of the 2 in the same patient is infrequent. During examination of operatively excised aortic and mitral valves because of dysfunction (stenosis and/or regurgitation), we encountered 16 patients who had congenitally bicuspid aortic valves associated with various types of dysfunctioning mitral valves. Eleven of the 16 patients had aortic stenosis (AS): 5 of them also had mitral stenosis, of rheumatic origin in 4 and secondary to mitral annular calcium in 1; the other 6 with aortic stenosis had pure mitral regurgitation (MR) secondary to mitral valve prolapse in 3, to ischemia in 2, and to unclear origin in 1. Of the 5 patients with pure aortic regurgitation, each also had pure mitral regurgitation: in 1 secondary to mitral valve prolapse and in 4 secondary to infective endocarditis. In conclusion, various types of mitral dysfunction severe enough to warrant mitral valve replacement occur in patients with bicuspid aortic valves. A proper search for mitral valve dysfunction in patients with bicuspid aortic valves appears warranted.
 ...
PMID:Presence of a congenitally bicuspid aortic valve among patients having combined mitral and aortic valve replacement. 2201 39

There is a relative dearth of fundamental anatomic information regarding the radial component of right and left coronary ostial location along the circumference of the aortic root. Recent literature has emphasized the importance of this anatomic component in the orientation of coronary buttons for the composite graft operation, especially as regards the use of porcine biological roots or design of novel mechanical or biological composite grafts. Problems in orientation of reattached buttons can lead to life-threatening ischemia. We assessed the radial location of native coronary arteries or coronary artery buttons by high-definition computed tomography scan in 100 patients (75 consecutive aneurysm patients undergoing aortic root replacement [ARR] and 25 control patients undergoing coronary artery bypass). We excluded six patients with unclear coronary anatomy and one with an anomalous origin. The center point of the aortic lumen was located, radii were drawn from there to each coronary ostium, and the angle was computed geometrically. The mean angle between the radii for the right and left coronary ostia was 122.9 degrees. The angle was similar for bicuspid and tri-leaflet aneurysm patients, 121.0 and 122.7 degrees, respectively. The angle was similar for aneurysm patients (121.6 degrees) and for controls (126.5 degrees). The angle showed very little variation among individuals for the overall group (standard deviation [SD] 13.1 degrees), for the aneurysm patients (SD 13.4 degrees), and for the controls (SD 12 degrees). This angle is different from that of the porcine roots (145 degrees) which are commonly used for ARR. The normal human angular separation between the right and left coronary ostia is 122.9 degrees for both aneurysm and control patients. This anatomic relationship is very different from that of porcine aortic roots. This anatomy needs to be borne in mind intraoperatively. This anatomic relationship can be used in the design of novel aortic root biological or composite grafts.
...
PMID:Anatomy of Main Coronary Artery Location: Radial Position around the Aortic Root Circumference. 2399 54

Aortic dissection is a life-threatening emergency. Well-established risk factors include systemic hypertension, hereditary connective tissue diseases (Marfan syndrome and Ehlers-Danlos syndrome), coarctation of the aorta, bicuspid aortic valve, aortitis, and arch hypoplasia. Ischemia of the viscera, the kidneys, the spinal cord, or the lower extremities due to malperfusion constitutes life-threatening complications that have to be considered in the treatment strategy.We report a rare case of symptomatic ischemia of the lower extremities due to aortic dissection. This case demonstrates that the treating physician needs to be vigilant for ischemia reperfusion injuries such as osteofascial compartment syndrome and acute renal failure in aortic dissection.
 ...
PMID:Ischemia-reperfusion injury in an aortic dissection patient. 2566 58

A 61-year-old male with a prosthetic St Jude aortic valve size 24 presented with heart failure symptoms and minimal-effort angina. Eleven months earlier, the patient had undergone cardiac surgery because of an aortic root dilatation and bicuspid aortic valve with severe regurgitation secondary to infectious endocarditis by Coxiela burnetii and coronary artery disease in the left circumflex coronary artery. Then, a prosthesis valve and a saphenous bypass graft to the left circumflex coronary artery were placed. The patient was admitted to the Cardiology Department of Hospital Universitario de Canarias, Tenerife, Spain and a transthoracic echocardiography was performed that showed severe paraprosthetic aortic regurgitation and an aortic pseudoaneurysm. The 64-slice multidetector computed tomography confirmed the pseudoaneurysm, originating from the right sinus of Valsalva, with a compression of the native right coronary artery and a normal saphenous bypass graft. On the basis of these findings, we performed surgical treatment with a favorable postoperative evolution. In our case, results from complementary cardiac imaging techniques were crucial for patient management. The multidetector computed tomography allowed for a confident diagnosis of an unusual mechanism of coronary ischemia.
 ...
PMID:Compression of the right coronary artery by an aortic pseudoaneurysm after infective endocarditis: an unusual case of myocardial ischemia. 2931 5


1