RESUMO
BACKGROUND: The incidence of milking phenomenon is between 0.6 and 4 % in angiographic series; however, autopsy studies raise the incidence of myocardial bridges up to 85 %. This malformation goes unnoticed in most cases but can have a big impact on personal and professional level. The objective was to present an example of milking phenomenon with disability and professional consequences. CLINICAL CASE: Male, 44 years old, bricklayer and farmhand laborer. He referred tonsillectomy and osteoarthritis and being a smoker of 10 cigarettes per day, drinking 2-3 cups of coffee daily and 2-3 glasses of wine at the weekends. The primary care physician referred him to cardiologist with suspicion of arrhythmia. The cardiology service report mentioned electrocardiogram at sinusal rhythm, 90 beats per minute and incomplete right bundle-branch block. At ergonomics test, in the first stage of Bruce protocol, the patient's development of hypertensive crisis suggested a milking phenomenon. Finally, the diagnosis was established by angiographic studies with left common branch, circumflex coronary artery, right coronary artery and anterior descendent artery, without evidence of pathology but it was seen systolic compression on the medial segment. The case was concluded by the disability assessment team, recognizing a total permanent disability with limitations for activities requiring moderate physical efforts. CONCLUSIONS: The milking phenomenon diagnosis that could be related with ischemic heart disease is by angiography. Finally, the patient ended with total permanent disability.
INTRODUCCIÓN: según series angiográficas, la incidencia del fenómeno de milking oscila entre 0.6 y 4 %, sin embargo, en estudios de autopsias hasta en 85 % se ha identificado puente miocárdico, patognómónico de este trastorno. La malformación del fenómeno de milking no es identificada en la mayoría de las ocasiones, pero puede tener grandes repercusiones. El propósito es ejemplificar un caso de fenómeno de milking con consecuencias de incapacidad permanente y consecuencias laborales. CASO CLÍNICO: hombre de 44 años de edad que laboralmente se ocupaba como peón albañil y peón agrícola. Como antecedentes refirió amigdalectomía y artrosis, tabaquismo de 10 cigarrillos diarios, dos o tres tazas de café diarias y dos o tres copas de vino en fin de semana. Mediante electrocardiograma se identificó ritmo sinusal y bloqueo incompleto de la rama derecha del fascículo atrioventricular. Su frecuencia cardiaca fue de 90 latidos por minuto. Para la prueba de esfuerzo se utilizó el protocolo de Bruce, que se detuvo en el primer estadio debido a crisis hipertensiva y fibrilación auricular paroxística. El cateterismo mostró tronco común izquierdo, arteria coronaria cincunfleja y arteria coronaria derecha sin lesiones, arteria descendente anterior sin lesiones con trayecto intramiocárdico y compresión sistólica en segmento medio, con lo cual se integró el diagnóstico de milking coronario. El paciente requirió incapacidad permanente total con limitación para actividades que necesitaran esfuerzo moderado. CONCLUSIONES: el diagnóstico del fenómeno de milking es angiográfico. Este trastorno puede estar relacionado con cardiopatía isquémica aguda. Este caso terminó con incapacidad permanente laboral.
Assuntos
Anomalias dos Vasos Coronários/diagnóstico , Adulto , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/fisiopatologia , Humanos , MasculinoRESUMO
The anomalous left coronary artery from the pulmonary artery is a rare disease. Therefore, it is a major congenital coronary anomaly. The clinical course depends on the formation and development of collateral arteries. The pathophysiology is explained by the low pressure in the pulmonary arterial system, with the right coronary artery (RCA) filling the left coronary artery in a retrograde manner through collateral arteries, working as a phenomenon of coronary flow theft. This study reports a case in which another finding was observed. The flow pattern in the left coronary artery in its distal segment evaluated by pulsed Doppler confirms the diagnosis confirmed by angiography...
El origen anómalo de la arteria coronaria izquierda a partir del tronco de la arteria pulmonar es una enfermedad rara, no obstante es una importante anomalía congénita coronaria. El curso clínico depende de la formación y desarrollo de colaterales. La fisiopatología es explicada por la baja presión en el sistema arterial pulmonar, con la arteria coronaria derecha (ACD) llenando la arteria coronaria izquierda de forma retrógrada, a través de colaterales, funcionando como un fenómeno del robo de flujo coronario. Será relatado un caso en que fue observado otro hallazgo, el estándar del flujo en la arteria coronaria izquierda en su segmento distal, evaluado por el Doppler pulsado, corrobora el diagnóstico, que fue ratificado por la angiotomografía...
A origem anômala da artéria coronariana esquerda a partir do tronco da artéria pulmonar é uma doença rara, entretanto, uma importante anomalia congênita coronariana. O curso clínico depende da formação e desenvolvimento de colaterais. A fisiopatologia é explicada pela baixa pressão no sistema arterial pulmonar, com a artéria coronariana direita enchendo a artéria coronariana esquerda de forma retrógrada, através de colaterais, funcionando como um fenômeno do roubo de fluxo coronariano. Será relatado um caso em que foi observado outro achado: o padrão do fluxo na artéria coronariana esquerda em seu segmento distal, avaliado pelo Doppler pulsado, corrobora o diagnóstico, que foi ratificado pela angiotomografia...
Assuntos
Humanos , Masculino , Adulto , Anomalias dos Vasos Coronários/fisiopatologia , Anormalidades Congênitas , Artéria Pulmonar/anormalidades , Ecocardiografia , SíndromeRESUMO
The median survival of patients with truncus arteriosus is five weeks of age with rare cases reaching adulthood. The longest reported survivor with balanced ventricles, as the index case has, is 38 years of age. The index case is a 46-year old male with Type 3 truncus arteriosus. His case has never been documented in the English Literature as far as the author is aware.
Assuntos
Circulação Colateral , Anomalias dos Vasos Coronários/fisiopatologia , Hipertensão Pulmonar/fisiopatologia , Persistência do Tronco Arterial/fisiopatologia , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/mortalidade , Humanos , Hipertensão Pulmonar/complicações , Hipertensão Pulmonar/mortalidade , Masculino , Pessoa de Meia-Idade , Policitemia/complicações , Persistência do Tronco Arterial/complicações , Persistência do Tronco Arterial/mortalidadeRESUMO
Studies on cardiac regeneration require large mammalian models of dilated cardiomyopathy (DCM) after acute myocardial infarction (AMI), and pig and sheep models are increasingly used in this field of preclinical research. Given the large interindividual variability in ovine left anterior descending artery (LAD) anatomy, protocols based on the coronary arteries to be ligated often lead to significant variation in infarct sizes and hence to heterogeneous results, ranging from no ventricular remodeling to acute, lethal left ventricular (LV) failure. We designed an ovine model of postinfarction DCM based on estimated infarct size rather than on a predetermined menu of coronary artery ligatures. In seven adult sheep we induced an anterolateral AMI of approximately 25% of the LV mass by ligating the branches of the LAD that, by visual inspection, would lead to such an infarct size. In 10 to 12 weeks, LV end-diastolic volume more than doubled and LV end-systolic volume almost tripled. LV ejection fraction decreased dramatically, as did LV percent fractional shortening and LV percent wall thickening. Infarct size (planimetry) was approximately 25% of the LV endocardial surface. We conclude that in sheep, an anterolateral AMI of approximately 25% of the LV mass--regardless of the coronary branches ligated to attain that infarct size--results in a model of postinfarction DCM that may prove useful in preclinical research on myocardial regeneration.
Assuntos
Cardiomiopatia Dilatada/fisiopatologia , Infarto do Miocárdio/fisiopatologia , Animais , Cardiomiopatia Dilatada/patologia , Anomalias dos Vasos Coronários/patologia , Anomalias dos Vasos Coronários/fisiopatologia , Vasos Coronários/patologia , Vasos Coronários/fisiopatologia , Infarto do Miocárdio/patologia , Ovinos , Disfunção Ventricular Esquerda/patologia , Disfunção Ventricular Esquerda/fisiopatologiaRESUMO
A two coronary system is preferred for correcting anomalous left coronary artery from the pulmonary artery (ALCAPA); however, translocation is not always possible. In countries where neonatal arterial switch operations have not been perfected coronary transfer can be difficult. The purpose of this report is to describe the intermediate results using the coronary elongation and translocation technique in developing countries. Records of patients undergoing operation by the International Children's Heart Foundation team were reviewed (April 1993-October 2008) for those undergoing ALCAPA repair. All patients received a 2-D echocardiographic-color Doppler examination prior to discharge and at follow-up. A total of 13 patients were identified, age ranged from 9 days to 41 years. All but one patient were operated upon at one of our affiliate hospitals in Croatia, Belarus, China and Colombia. All patients presented with moderate to severe mitral regurgitation and cardiac failure. Follow-up ranged from six months to 9.5 years postoperatively. Color Doppler showed a patent left coronary artery; echocardiography estimated a normal left ventricular ejection fraction and improved mitral regurgitation in all patients. The technique provides an alternative approach to translocation for ALCAPA in countries where routine neonatal coronary transfer techniques may not be perfected. Intermediate results are comparable to translocation.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Anomalias dos Vasos Coronários/cirurgia , Artéria Pulmonar/cirurgia , Adulto , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/mortalidade , Criança , Pré-Escolar , China , Colômbia , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/mortalidade , Anomalias dos Vasos Coronários/fisiopatologia , Países em Desenvolvimento , Ecocardiografia Doppler em Cores , Europa Oriental , Feminino , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/cirurgia , Humanos , Lactente , Recém-Nascido , Masculino , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/cirurgia , Artéria Pulmonar/anormalidades , Artéria Pulmonar/diagnóstico por imagem , Volume Sistólico , Fatores de Tempo , Resultado do Tratamento , Estados Unidos , Grau de Desobstrução Vascular , Função Ventricular EsquerdaRESUMO
Anomalous coronary arteries arising from the pulmonary trunk is a rare but potentially fatal condition. We report the clinical presentation, surgical treatment and long-term follow-up of seven surgical cases of anomalous left coronary and one case of anomalous right coronary artery arising from the pulmonary artery. Age ranged from 7 months to 13 years (average: 5.09+/-3.7 years) and weight ranged from 7 to 50 kg (average: 19.9+/-8.8 kg). Follow-up was 100% complete: average 78 months (S.D.: 52.7 months). Direct reimplantation was the surgical technique in six cases, Takeuchi procedure in one case and subclavian artery interposition in one case. Concomitant mitral valve repair was undertaken in two cases. In two children the coronary artery anomaly was diagnosed and treated only after a first surgery for other congenital heart anomaly. Left ventricle ejection fraction was restored in those cases of pre-operative dysfunction. Mortality was not observed and all children are asymtomatic and free of reoperation.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Anomalias dos Vasos Coronários/cirurgia , Artéria Pulmonar/cirurgia , Adolescente , Implante de Prótese Vascular , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Criança , Pré-Escolar , Anomalias dos Vasos Coronários/fisiopatologia , Feminino , Humanos , Lactente , Masculino , Artéria Pulmonar/anormalidades , Reimplante , Volume Sistólico , Artéria Subclávia/cirurgia , Fatores de Tempo , Resultado do Tratamento , Função Ventricular EsquerdaRESUMO
BACKGROUND: Evaluation of a case series of anomalous origin of the left coronary artery from the pulmonary artery corrected with the Takeuchi procedure, analyzing their immediate and late surgical outcomes as well as the related morbidity. OBJECTIVE: To report a case series of anomalous origin of the left coronary artery from the pulmonary artery corrected with the Takeuchi procedure. METHODS: The analysis was based on data collected from the medical records of 12 patients undergoing surgical correction between 1981 and 2003. RESULTS: The mean age of the patients was 5.9 +/- 1.7 months. The predominant manifestation was heart failure, especially in the infants. The baseline electrocardiogram showed a Q wave in DI and aVL and signs of myocardial ischemia in ten cases. Echocardiogram with a pattern of dilated cardiomyopathy and mitral regurgitation was found in six patients. The mean age at surgical correction was 31.8 +/- 14.3 months. The immediate surgical mortality was 16% (two patients), from cardiac dysfunction. In the outpatient follow-up we observed that the symptoms, ischemic electrocardiographic changes, cardiac function and mitral regurgitation improved. Three cases progressed with supravalvar pulmonary stenosis during follow-up. CONCLUSION: This heart disease should be suspected in every infant presenting with heart failure. Surgical correction with the Takeuchi procedure has proven efficient, with a low mortality rate. Cardiac function returns to normal and mitral regurgitation improves after surgical correction.
Assuntos
Anomalias dos Vasos Coronários/cirurgia , Insuficiência Cardíaca/cirurgia , Insuficiência da Valva Mitral/cirurgia , Artéria Pulmonar/anormalidades , Procedimentos Cirúrgicos Vasculares/métodos , Adolescente , Criança , Pré-Escolar , Anomalias dos Vasos Coronários/fisiopatologia , Ecocardiografia Doppler , Eletrocardiografia , Feminino , Seguimentos , Insuficiência Cardíaca/fisiopatologia , Humanos , Lactente , Masculino , Valva Mitral/fisiopatologia , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/fisiopatologia , Artéria Pulmonar/cirurgia , Estudos RetrospectivosRESUMO
FUNDAMENTO: Avaliação dos casos de origem anômala da artéria coronária esquerda do tronco pulmonar operados com a técnica de Takeuchi, analisando o resultado cirúrgico imediato e tardio e a morbidade destes pacientes. OBJETIVO: Relato uma série de casos de origem anômala da artéria coronária esquerda do tronco pulmonar operados com a técnica de Takeuchi. Métodos: Realizou-se a análise com coleta de dados dos prontuários de doze pacientes submetidos à correção cirúrgica no período de 1981 a 2003. RESULTADOS: A idade média dos pacientes foi de 5,9 ± 1,7 meses. A clínica preponderante foi insuficiência cardíaca, principalmente nos lactentes. O eletrocardiograma inicial em dez casos mostrou onda Q em DI e aVL e sinais de isquemia miocárdica. No ecocardiograma, observaram-se padrão de miocardiopatia dilatada em seis pacientes e insuficiência mitral. A idade média da correção cirúrgica foi de 31,8 ± 14,3 meses. A mortalidade cirúrgica imediata foi de 16 por cento (dois pacientes) por disfunção cardíaca. No acompanhamento ambulatorial, houve a melhora da sintomatologia e das alterações isquêmicas no eletrocardiograma, retorno da função cardíaca e melhora da insuficiência mitral. Durante o acompanhamento, três casos evoluíram com estenose supravalvar pulmonar. CONCLUSÃO: A suspeita clínica dessa cardiopatia deve ser feita em todo lactente com insuficiência cardíaca. A correção cirúrgica com o emprego da técnica de Takeuchi se mostra eficaz, com baixo índice de mortalidade. Após a correção, há um retorno à normalidade da função cardíaca e a melhora da insuficiência mitral.
BACKGROUND: Evaluation of a case series of anomalous origin of the left coronary artery from the pulmonary artery corrected with the Takeuchi procedure, analyzing their immediate and late surgical outcomes as well as the related morbidity. OBJECTIVE: To report a case series of anomalous origin of the left coronary artery from the pulmonary artery corrected with the Takeuchi procedure. METHODS: The analysis was based on data collected from the medical records of 12 patients undergoing surgical correction between 1981 and 2003. RESULTS: The mean age of the patients was 5.9 ± 1.7 months. The predominant manifestation was heart failure, especially in the infants. The baseline electrocardiogram showed a Q wave in DI and aVL and signs of myocardial ischemia in ten cases. Echocardiogram with a pattern of dilated cardiomyopathy and mitral regurgitation was found in six patients. The mean age at surgical correction was 31.8 ± 14.3 months. The immediate surgical mortality was 16 percent (two patients), from cardiac dysfunction. In the outpatient follow-up we observed that the symptoms, ischemic electrocardiographic changes, cardiac function and mitral regurgitation improved. Three cases progressed with supravalvar pulmonary stenosis during follow-up. CONCLUSION: This heart disease should be suspected in every infant presenting with heart failure. Surgical correction with the Takeuchi procedure has proven efficient, with a low mortality rate. Cardiac function returns to normal and mitral regurgitation improves after surgical correction.
Assuntos
Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Anomalias dos Vasos Coronários/cirurgia , Insuficiência Cardíaca/cirurgia , Insuficiência da Valva Mitral/cirurgia , Artéria Pulmonar/anormalidades , Procedimentos Cirúrgicos Vasculares/métodos , Anomalias dos Vasos Coronários/fisiopatologia , Ecocardiografia Doppler , Eletrocardiografia , Seguimentos , Insuficiência Cardíaca/fisiopatologia , Insuficiência da Valva Mitral/fisiopatologia , Valva Mitral/fisiopatologia , Valva Mitral/cirurgia , Artéria Pulmonar/cirurgia , Estudos RetrospectivosRESUMO
Many surgical procedures for the implantation of anomalous left coronary artery from pulmonary artery have been described. A dual coronary system offers most benefit and is most advantageous for the patient. Two autogenous flaps of the pulmonary trunk and ascending aorta, without mobilizing the coronary artery, were created for use in this procedure. This technique was successfully used in an 8 month-old patient with severe myocardial dysfunction and moderate mitral regurgitation. This procedure allows 2 coronary systems to be repaired for any anatomic change of the left coronary artery without the use of prosthetic material. There were no technical complications. During the postoperative course minimal inotropic support was used. The magnetic resonance study, 11 months postoperative, showed wood flow of the left coronary artery and mild mitral regurgitation. The operative technique was simple and its execution easy. The follow-up in the intermediate and late period showed the growth of this endothelized tube.
Assuntos
Aorta/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Anomalias dos Vasos Coronários/cirurgia , Artéria Pulmonar/cirurgia , Anastomose Cirúrgica/métodos , Circulação Coronária/fisiologia , Anomalias dos Vasos Coronários/fisiopatologia , Humanos , Lactente , Masculino , Retalhos CirúrgicosRESUMO
Objective - Anomalous origin of the left coronary artery from the right pulmonary artery (AOLCARPA), is a rare entity that is usually associated with other defects. Of the 20 cases of AOLCARPA reported in the literature, 14 (70 per cent) had associations. We describe four patients with AOLCARPA without associated defects, but with a peculiar intramural aortic trajectory. Methods - Fifty-five patients with anomalous origin of the left coronary artery were operated upon at INCORFMUSP. Four of the patients had the anomalous origin from the right pulmonary artery (RPA) without associated defects but with intramural aortic trajetory. Clinical and laboratory examinations were analyzed, as well as surgical findings. Results - All patients had congestive heart failure (CHF) and 3 also had angina pectoris. Two patients had a murmur of mitral regurgitation, signs of myocardial infarction on the ECG and cardiomegaly. The shortening fraction varied from 9 per cent to 23 per cent. The hemodynamic study confirmed the diagnosis of anomalous origin of the coronary artery, but the intramural trajetory and the origin from the RPA were established only at surgery. In 3 patients, the technique of side-to-side anastomosis was performed with a good outcome. One patient, who underwent end-to-side anastomosis, died 6 months after the surgery. Conclusion - Association with other defects usually occurs in the AOLCARPA, and the intramural aortic trajectory is difficult to clinically diagnose but easy to surgically correct.
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Aorta , Anomalias dos Vasos Coronários/fisiopatologia , Artéria Pulmonar/anormalidades , Anomalias dos Vasos Coronários/diagnóstico , Anomalias dos Vasos Coronários/cirurgia , Insuficiência Cardíaca , Artéria Pulmonar/cirurgiaRESUMO
Com o objetivo de fazer um estudo, em microscópio de luz, das pontes de miocárdio sobre as veias cardíacas, utilizaram-se 5 corações de suínos de ambos os sexos. Esses corações foram fixados em formol a 10 por cento, por um período de 10 dias, embebidos em parafina e submetidos a cortes histológicos seriados de 15µm de espessura. A seguir, os cortes foram corados pelos métodos de Azan e Weigert-van Gieson. Verificou-se que as pontes de miocárdio eram constituídas por fibras da camada superficial do miocárdio. A parede dos segmentos venosos pré-pontino pós-pontino e pontino das veias cardíacas magna e média de suínos era delgada e possuía características semelhantes. A túnica média apresentava modificações estruturais de acordo com a localizaçäo no plano subepicárdico: fibromuscular, próxima ao ápice cardíaco, e fibroelástica, no restante do trajeto. Sob o ponto de vista morfofuncional, as pontes de miocárdio podem ser consideradas como um fator coadjuvante do retorno venoso.
Assuntos
Animais , Masculino , Feminino , Anomalias dos Vasos Coronários/fisiopatologia , Vasos Coronários/ultraestrutura , SuínosRESUMO
Coronary artery fistula is a rare congenital anomaly in which the involved coronary artery empties into a cardiac chamber, pulmonary artery, or other structure. Its diagnosis can be made noninvasively by finding a dilated coronary artery by 2-dimensional (2D) echocardiography, and its drainage can be detected by color flow mapping. We describe features of coronary artery fistulas in 8 patients whose condition was prospectively diagnosed by Doppler echocardiography with color flow mapping. The right coronary artery was involved in 4 cases and the left coronary artery in 4. Four fistulas drained to the right ventricle, 2 to the right atrium, and 2 to the pulmonary artery. In 1 patient who had left and right coronary fistulas to the pulmonary artery, only the first was diagnosed noninvasively. The diagnosis of coronary fistulas can usually be made by 2D echocardiography with color flow mapping. However, fistulas to the pulmonary artery may be more difficult to detect by 2D echocardiography because the coronary artery may be of normal size and the shunt small.
Assuntos
Anomalias dos Vasos Coronários/diagnóstico por imagem , Ecocardiografia Doppler , Fístula Vascular/congênito , Fístula Vascular/diagnóstico por imagem , Adolescente , Adulto , Artérias/diagnóstico por imagem , Criança , Pré-Escolar , Anomalias dos Vasos Coronários/fisiopatologia , Eletrocardiografia , Feminino , Humanos , Lactente , Masculino , Fístula Vascular/fisiopatologiaRESUMO
The evaluation of left ventricular function with dobutamine stress echocardiography is described for the first time in a patient with anomalous left coronary artery from the pulmonary trunk during the preoperative and postoperative periods. This method demonstrated signs of myocardial ischemia that were not seen on the resting echocardiogram during the preoperative period and ventricular function recovery after surgical intervention.
Assuntos
Cardiotônicos , Anomalias dos Vasos Coronários/diagnóstico por imagem , Dobutamina , Ecocardiografia Transesofagiana/métodos , Função Ventricular Esquerda , Criança , Anomalias dos Vasos Coronários/fisiopatologia , Eletrocardiografia , Feminino , HumanosRESUMO
BACKGROUND: The relationship between myocardial bridging (MB) and ischemic heart disease is still controversial. However, a recent new evidence suggests that this relation is not by chance. PURPOSE: The purpose of our study was to review in a critical manner, the evidence for the relationship between MB and myocardial ischemia and its possible consequences. METHODS: We present 2 cases of our series and review the medical literature from January 1966 to January 1998 published and included in Medline and Current Contents. RESULTS AND CONCLUSIONS: The principal findings after this review were: 1) MB is not a normal variant; 2) The clinical impact of MB depends on its anatomical extension and degree of compressive effect; 3) The MB muscle is not similar to myocytes from other cardiac areas; 4) The environment surrounding coronary artery may be a crucial factor in determining whether the MB influences the induction of heart disorders or not; 5) The overshoot due to compressive effect on coronary artery might determine endothelial injury in the microcirculation post-MB; 6) In some cases, the systolic endothelial injury may contribute to release factors that are able to reduce the coronary reserve, resulting in myocardial ischemia; 7) The possible role of PTCA in this disorder still has to be proven. Surgical treatment should be considered when important myocardial ischemia had been demonstrated, even in those asymptomatic cases.
Assuntos
Circulação Coronária , Anomalias dos Vasos Coronários/fisiopatologia , Endotélio Vascular/fisiopatologia , Isquemia Miocárdica/fisiopatologia , Adulto , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/cirurgia , Eletrocardiografia , Endotélio Vascular/patologia , Feminino , Humanos , Microcirculação , Isquemia Miocárdica/complicações , Isquemia Miocárdica/cirurgiaRESUMO
The authors describe the morphogenesis and functional alterations of the coronary arterial net in the ectopic coronary arteries: a) with origin in the aorta or its branches and b) with origin in the pulmonary artery. The coronary arteries are developed from: 1) endothelial sprouts localized in the great arteries walls at the level of the sigmoidal values, 2) right and left subepicardial vascular network and 3) the intramyocardial sinusoids. Most of the ectopic coronary arteries result from alterations in the connection between these three embryonic elements. The deviation of one of the subepicardial vascular network in a wrong way (in direction of pulmonary artery or the opposite Valsalva sinus) will stimulate the development of endothelial sprouts which will connect such network originating abnormal connections and anomalous origin of the coronary arteries. The origin of both coronary arteries from the pulmonary artery is in compatible with life. Myocardial ischemia is absent in patients with type I (infant) or type II (adult) anomalous origin of one coronary artery from the pulmonary artery, only in the transitional phase between both types (I and II) there is myocardial ischemia previous to the formation of the collateral coronary circulation. The ectopic origin of the coronary artery from the aortic Valsalva sinus have very little hemodynamic repercussion in the patient. Although there are cases with postexercise sudden dead. These anomalies associated to atherosclerotic coronary stenosis have an impact on the evolution and prognosis of ischemic heart disease.
Assuntos
Aorta , Coristoma/fisiopatologia , Doença das Coronárias/fisiopatologia , Anomalias dos Vasos Coronários/fisiopatologia , Artéria Pulmonar , Seio Aórtico , Adulto , Cateterismo Cardíaco , Coristoma/complicações , Coristoma/diagnóstico , Angiografia Coronária , Doença das Coronárias/complicações , Doença das Coronárias/diagnóstico , Anomalias dos Vasos Coronários/diagnóstico , Anomalias dos Vasos Coronários/etiologia , Feminino , Humanos , Recém-Nascido , Masculino , Pessoa de Meia-Idade , MorfogêneseRESUMO
Origem anômala da artéria coronária esquerda na artéria pulmonar em paciente do sexo feminino, com 50 anos, cujo quadro clínico inicial foi angina de esforço há oito meses. Säo descritos o quadro clínico, a fisiopatologia e o diagnóstico
Anomalous origin of the left main coronary artery from the pulmonary artery in a 50 year-old patient whose initial symptom was effort angina during the last 8 months. The clinical features and treatment are also discussed.