A atresia do tronco da coronária esquerda é uma rara anomalia coronária na qual não se identifica o óstio da coronária esquerda e a porção proximal do tronco termina abruptamente. Dessa forma, a coronária esquerda apresenta fluxo retrógrado a partir de colaterais provenientes da coronária direita. A circulação colateral que nutre a coronária esquerda parte em geral da artéria do cone e anastomoses intrasseptais, ventriculares anteriores e posteriores. ABSTRACT Congenital Atresia of the Left Main Coronary Artery in a Young Adult: A Rare and Potentially Fatal Coronary AnomalyWe report the case of a 35-year-old male patient with congenital atresia of the left main coronary artery, a rare disease with few cases reported in the literature. In this anomaly, the left coronary ostium is absent, the proximal left main trunk ends blindly and blood flow is retrograde from the right to the left coronary artery by small collateral arteries. Differential diagnosis includes other congenital malformations (single right coronary artery and anomalous origin of the left coronary artery from the pulmonary artery) and acquired atherosclerotic disease of the left main coronary artery. KEY-WORDS:Heart defects, congenital. Coronary vessels. Coronary disease. Myocardial revascularization. RESUMORelato do caso de paciente do sexo masculino, 35 anos de idade, com atresia congênita do tronco da artéria coronária esquerda, afecção extremamente rara e com poucos casos descritos na literatura. Nessa afecção, o óstio da coronária esquerda está ausente, o tronco da coronária esquerda termina em fundo cego e o fluxo sanguíneo se dá da coronária direita para a esquerda por pequenas artérias colaterais e retrogradamente. O diagnóstico diferencial envolve outras malformações congê-nitas (artéria coronária direita única e origem anômala da artéria coronária esquerda do tronco da artéria pulmonar) e doença aterosclerótica adquirida do tronco da coronária esquerda. DESCRITORES: Cardiopatias congênitas. Vasos coronários. Doenças das coronárias. Revascularização miocárdica.A atresia pode ser verdadeira ou o tronco pode ser hipoplásico. De qualquer forma, a afecção é grave e pode levar o paciente à morte. Essa afecção é classificada nas formas infantil e adulta. Na forma infantil, coexistem outros defeitos cardíacos, entre os quais o mais frequente é a estenose aórtica supravalvar. Na forma adulta, em geral não se detectam anomalias associadas.Relatamos a seguir um caso de apresentação tardia da doença (forma adulta). RELATO DO CASOPaciente de 35 anos, sexo masculino, branco, casado, natural e procedente de São Paulo (SP, Brasil), previamente assintomático. Esportista até os 34 anos de idade, quando, por motivos profissionais, interrompeu a prática de atividade física. Um ano após, por desejar retomar a prática esportiva e considerando-se
Introduction: Pulmonary hypertension (PH), a serious clinical condition, can lead to right ventricular systolic dysfunction (RVSD) with prognostic implications. Patients with suspected PH should undergo transthoracic echocardiography (TTE) for diagnosis and evaluation as the main screening and follow-up exam. Objective: To verify the associations of and agreement between measurements of mean pressure in the right atrium (RA) and RVSD with TTE Method: Individuals diagnosed with PH were included. All patients underwent TTE and RCC. The following were evaluated by TTE: right atrial area (RAA), mean right atrial pressure through the diameter and collapsibility of the inferior vena cava (RMAPTTE), RA strain (RAS), tricuspid annular plane systolic excursion, fractional area change, RV free wall strain, and tricuspid s’ wave. Mean RA pressure (RMAPRCC) and cardiac index (CI) were evaluated through the RCC. Results: Of the 16 patients, 13 were female. The mean patient age was 44.4 (±14.9) years. An association was found between RMAPRCC and AAD, RMAPTTE, and RAS (r=0.845, r=0.621, and r=-0.523, respectively; p<0.05). There was an association between the mortality risk categories measured by the RAA and RMAPRCC measures (X2=10.42; p=0.003), with moderate agreement (k=0.44; p=0.012). RVSDJ was present in 10 patients. There was an association between RVSD (present or absent) and CI (r=0.522; p=0.04) with moderate agreement (k=0.43; p=0.037). Conclusion: The TTE and RCC measurements showed an association in the assessment of mean right atrial pressure, especially between RAA and RMAPRCC. An association with RVSD and moderate agreement between methods were also noted.
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