Anomalous left coronary artery from the pulmonary artery, or ALCAPA syndrome, is a rare congenital cardiac disease that can cause myocardial infarction, heart failure and even death in paediatric patients. Only few untreated patients survive until adult age. Here we present the case of a 33-year-old female patient with paroxysmal tachycardia, syncope and mild exertional dyspnoea. She was diagnosed with ALCAPA syndrome and underwent surgical correction with an alternative technique of left main coronary artery extension to the aorta.

Anomalous left coronary artery from the pulmonary artery, or ALCAPA syndrome, is a rare congenital cardiac disease that can cause myocardial infarction, heart failure and even death in paediatric patients. Only few untreated patients survive until adult age. Here we present the case of a 33-year-old female patient with paroxysmal tachycardia, syncope and mild exertional dyspnoea. She was diagnosed with ALCAPA syndrome and underwent surgical correction with an alternative technique of left main coronary artery extension to the aorta.

Introduction?The digital subtraction angiography is considered the gold standard in detecting cerebral aneurysms. Other less invasive techniques that require a lesser dose of contrast medium are currently employed such as rotational angiography (RA) and computed tomography angiography with three-dimensional reconstruction (3D-CTA). The aim of this study is to recommend 3D-CTA as a screening test for cerebral aneurysms in patients with suspected cerebrovascular pathology, having compared it to other tests requiring the use of less contrast medium, in this case, RA and 3D-CTA. Materials and Methods?The study was performed between 2010 and 2014 among all patients referred to the Centro M?dico Nacional ?20 de Noviembre? ISSSTE, in Mexico City, presenting a total of 332 patients with suspected cerebral aneurysm; 182 patients who had undergone angiography or digital subtraction angiography in a different hospital were not included, and 50 patients who tested negative for cerebral aneurysm were also excluded. Experts in neurological imaging examined the results, comparing those diagnosed with cerebral aneurysms, using RA and 3D-CTA against the gold standard. Results?Both RA and 3D-CTA registered the same aneurysm dimensions. Differences were observed in aneurysm's dome only. Conclusion?The RA should be reserved for those cases where a DSA is deemed necessary, but cannot be performed due to the high amount of contrast medium required and risk of adverse reactions in allergic population; in this case, the 3D-CTA is a better test.

Myocardial function recovery in ischemic cardiomyopathy patients requires engraftment of hematopoietic stem cells and coronary artery bypass grafting. Bypass surgery produces an inflammatory response that probably influences bloodstream stem cell mobilization. Although off-pump coronary surgery minimizes myocardial inflammation, the surgical bypass procedure produces myocardial inflammation thus influencing myocardial regeneration. Our aim was to determine if the inflammation associated to the bypass surgical procedure favors CD117+/CXCR4+ stem cell bloodstream mobilization. Method: Ten ml blood samples of 20 patients undergoing off-pump coronary revascularization open heart surgery were obtained pre-surgery, at the sternotomy moment, during Left Internal Thoracic Artery grafting, and at sternotomy closure. 1 ml of total blood was used to quantitate CD117+/CXCR4+ cells by flow cytometry with Specific monoclonal antibodies (BioLegend), whereas the remaining blood was used to obtain serum to evaluate IL-6, 8, TNFα, and SDF1α by chemiluminescence. Results: Pre-surgery IL-6 (10.2 pg/ml) and IL8 (18.6 pg/ml) serum concentration began to increase at the moment of sternotomy and reached their peak (79.1 and 28.4 pg/ml, respectively) at sternotomy closure; the already meaningful increase of IL-6 during Left Internal Thoracic Artery grafting (32.5 pg/ml) was associated with a significantly increase in SDF1α serum concentration (199 pg/ml vs 8.6 pg/ml pre-surgery value) and CD117+/CXCR4 + cell numbers (375x103 cells/ml vs 4x103 cell/ml pre-surgery value) that diminished to 114x103 cells/ml at sternotomy closure. Conclusion: CD117+/CXCR4+ stem cell mobilization in off-pump coronary artery bypass surgery is mediated by an increase in SDF1α result of an enhanced IL-6 and IL-8 serum concentration.