Journal of the American College of Cardiology
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J. Am. Coll. Cardiol. · Jan 1987
Case ReportsTwo-dimensional and Doppler echocardiographic diagnosis of an aortic to right atrial fistula complicating aortic dissection.
A 60 year old woman presented with massive aortic root dilation and sudden cardiovascular collapse 10 years after aortic valve replacement. An aortic to right atrial fistula was diagnosed by echocardiographic imaging and Doppler ultrasound. At operation, the patient was found to have chronic aortic dissection with aneurysm formation. Rupture of the aneurysm into the right atrium was confirmed.
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J. Am. Coll. Cardiol. · Nov 1986
Case ReportsSequelae of injury to the heart caused by multiple needles.
A case is reported in which multiple needles were inserted into the heart by a patient, resulting in the unusual combination of a coronary artery-cameral fistula to the left ventricle, an intramural defect of the left ventricular free wall and a ventricular septal defect. This unique lesion was suspected on the basis of two-dimensional and Doppler echocardiography and contrast computed tomographic imaging. Its presence was confirmed during cardiac catheterization and cineangiography.
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J. Am. Coll. Cardiol. · Oct 1986
Atrioventricular block in acute inferior wall myocardial infarction: harbinger of associated obstruction of the left anterior descending coronary artery.
In a prospective study 51 consecutive patients who survived the acute phase of inferior wall myocardial infarction underwent coronary arteriography. Eleven patients developed some degree of atrioventricular (AV) block in the acute phase of infarction that disappeared within a few days and was considered by electrocardiographic analysis to be located in the AV node. ⋯ Patients with inferior myocardial infarction and left anterior descending coronary artery obstruction have a sixfold greater chance of developing heart block in the acute phase of infarction than do patients with inferior infarction without such obstruction (p less than 0.05). These findings also support the observations that the proximal AV conduction system usually has a dual arterial blood supply from both the right and left anterior descending coronary arteries, and may explain the transient behavior of heart block and lack of necrosis of the AV node seen in these patients.
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J. Am. Coll. Cardiol. · Sep 1986
Case ReportsPersistent left superior vena cava communicating with the left atrium through a systemic-pulmonary venous malformation.
A 14 year old white girl who presented with a brain abscess was discovered to have a left pulmonary vascular malformation on a chest roentgenogram. Angiograms revealed a left superior vena cava that drained into a venous malformation within the left lung, then communicated with the left atrium by way of the left superior pulmonary vein. ⋯ There was mild systemic arterial hemoglobin desaturation, but no evidence of cyanosis. The embryology, physiology and surgical repair of this rare lesion and the complication of a postoperative superior vena cava syndrome are discussed.
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J. Am. Coll. Cardiol. · Sep 1986
Rupture of a left ventricular papillary muscle during acute myocardial infarction: analysis of 22 necropsy patients.
Certain clinical and cardiac morphologic findings are described in 22 patients, aged 45 to 80 years (mean 64) (15 men [68%]), in whom rupture of a papillary muscle occurred during acute myocardial infarction. In most, the acute infarction associated with papillary muscle rupture was a first coronary event (only 18% had a myocardial scar consistent with prior infarction and 29% had angina pectoris). ⋯ Quantitative examination of the amounts of narrowing by atherosclerotic plaque in each of the four major epicardial coronary arteries (right, left main, left anterior descending and left circumflex) disclosed less narrowing in the patients with rupture than in the patients with fatal acute myocardial infarction unassociated with rupture. Of the 519 five mm sections of coronary artery examined (11 patients), only 68 sections (13%) were narrowed greater than 75% in cross-sectional area compared with 34% of 1,403 sections from 27 patients with fatal myocardial infarction without rupture.