Information given by CE-CTC concerning colorectal cancer location and synchronous colonic cancers and polyps changed the laparoscopic surgical strategy in almost 14 % of patients.
The prevalence of synchronous CRC was about 4-6%. The introduction of CTC is associated with a significant increase of the prevalence of synchronous CRCs.
Congenital abnormalities of coronary arteries are an uncommon cause of sudden cardiac death and are difficult to detect at coronary angiography. We describe two patients with acute coronary syndrome and non-occlusive coronary artery disease in which a 64-multidetector computed tomography (MDCT) coronary angiography showed the presence of a malignant coronary anomaly. Sixty-four-MDCT with the possibility of 3D reconstructions allows for easier diagnosis of coronary anomalies and provides essential details necessary for operative intervention. doi: 10.1111/jocs.12040 (J Card Surg 2013;28:33-36) Congenital abnormalities of coronary arteries may be found incidentally in 0.3% to 1% of healthy individuals.
1They are an uncommon but important cause of chest pain, myocardial ischemia, and syncope and, above all, they carry a high risk for sudden cardiac death (up to 30% of patients), particularly before 35 years of age.
2The detection and characterization of these anomalies is crucial for the management of these patients. We describe two cases of patients with angina but nonsignificant coronary artery disease at angiography in which the coronary anomaly was diagnosed using a 64-MDCT (Light Speed VCT, General Electrics, Milwaukee, WI). The usefulness of this non-invasive diagnostic tool in the diagnosis of the coronary anomalies is the subject of this clinical review.
PATIENT 1A 66-year-old female with hypertension presented with sudden chest pain. The electrocardiogram (ECG) showed sinus rhythm with ST elevation in V2 and V3 leads. Blood tests revealed a slight increase of T-troponine (0.06 ng/mL-normal values 0.01 to 0.03 ng/mL). The patient underwent conventional coronary angiography (CCA) which revealed a myocardial bridge of the anterior descending artery and an anomalous origin of the right coronary artery (RCA), with no significant disease of the other epicardial vessels (Fig. 1a). Computed tomography coronary angiography (CTCA) confirmed the absence of significant atherosclerosis and the presence of a short intramyocardial path of the anterior descending coronary artery (Fig. 1c) and, in addition, revealed the aberrant origin of the RCA from the opposite coronary sinus (Fig. 1b). The patient, though informed about potential risks associated with this anomaly and available therapeutic options, refused any surgical intervention and agreed to long-term b-blocker medical therapy with a strict follow-up. She has remained asymptomatic at one-year follow-up.
PATIENT 2A 49-year-old male presented with chest pain. ECG showed sinus rhythm with ST elevation in all the electrocardiographic leads; the echocardiogram was normal; blood T-troponine values were 0.05 ng/mL. The patient underwent coronary angiography that showed non-occlusive coronary artery disease and revealed an aberrant origin of the dominant RCA from the left Disclosures: none.
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