A same-day-discharge ad hoc PCI strategy proved reliable and safe for most patients selected a priori on simple clinical criteria, entailing no unexpected complications due to shorter medical monitoring.

Aberrant coronary arteries are frequently observed in patients presenting with Fallot's tetralogy (TOF). Before the complete surgical repair of the TOF, the percutaneously performed pulmonary trunk (PT) angioplasty is often performed in order to temporarily increase the pulmonary circulation, thus increasing the pulmonary vessel size, finally improving surgical outcome. This case reports a 12-year-old boy with a TOF insufficiently improved by surgical correction, in whom a PT angioplasty with stent implantation was complicated by an extrinsic compression of an aberrant right coronary artery (RCA) causing a myocardial ischemia with severe hypotension. The RCA, originating from the left anterior descending coronary artery, passed through the aortic root and the PT and was thus compressed by the PT-stent. Finally the RCA was successfully treated with standard coronary balloon angioplasty and stenting, improving myocardial perfusion and the hemodynamics of the patient, who finally died several days thereafter due to septic shock and massive pulmonary embolism.

Myocardial bridge (MB) or tunneled coronary artery is an inborn abnormality, which implicates a systolic vessel compression with a persistent mid-late diastolic diameter reduction. Myocardial bridges are often observed during coronary angiography with an incidence of 0.5%-5.5%. The most involved coronary artery is the left anterior descending artery followed by the diagonal branches, the right coronary artery, and the left circumflex. The overall long-term prognosis is generally benign. However, several risk or precipitating factors (e.g., high heart rate, left ventricular hypertrophy, decreased peripheral vascular resistance) may trigger symptoms (most frequently angina). Herein, we describe two cases of symptomatic myocardial bridge, where medical treatment (i.e., inotropic negative drug) and coronary stenting were successfully utilized to treat this pathology. We also focus on the clinical presentation, and the diagnostic and therapeutic modalities to correctly manage this frequently observed congenital coronary abnormality, underlining the fact that in cases of typical angina symptoms without any significant coronary artery disease, MB should be considered as a possible differential diagnosis.

No abstract

No abstract