Coronary embolism following aortic and mitral valve replacement: Successful management with abciximab and urokinase

Quinn, Elizabeth G.; Fergusson, David J. G.

doi:10.1002/(sici)1097-0304(199804)43:4<457::aid-ccd24>3.0.co;2-f

Cited by 30 publications

(20 citation statements)

References 7 publications

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“…Interestingly, both modalities yielded comparable data regarding the extent of heterogeneous microinfarct scar, and they were not signifi cantly different from TTC staining microinfarct size. These fi ndings are in line with those of clinical studies, in which delayed contrast-enhanced multidetector percutaneous coronary intervention for atherosclerosis but include a wide range of abnormalities, such as valvular disease, prosthetic valve placement, endocarditis, cardiomyopathy with mural thrombus, arrhythmias, and heart-lung bypass (35)(36)(37)(38)(39)(40)(41). This disease has also been reported in patients with hypertension, diabetes ( 3 ), systemic lupus erythematosus ( 42 ), and sickle cell disease; in these patients, abnormally shaped erythrocytes obstructing the capillaries and small arterioles may cause microinfarct ( 43 ).…”

Section: Experimental Studies: Heterogeneous Microinfarcts Caused By supporting

confidence: 84%

Heterogeneous Microinfarcts Caused by Coronary Microemboli: Evaluation with Multidetector CT and MR Imaging in a Swine Model

Carlsson

Saloner²,

Martin³

et al. 2010

Radiology

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Purpose:To directly compare the sensitivity of 64-section multidetector computed tomography (CT) with that of 1.5-T magnetic resonance (MR) imaging in the depiction and measurement of heterogeneous 7-8-week-old microinfarcts and the quantification of regional left ventricular (LV) function and perfusion in the territory of coronary intervention in a swine model. Materials and Methods:Approval was obtained from the institutional animal committee. An x-ray/MR system was used to catheterize the left anterior descending (LAD) coronary artery with x-ray guidance and to delineate the perfusion territory. The vessel was selectively microembolized in six pigs with smalldiameter embolic material (40-120 µm, 250 000 count). At 7-8 weeks after microembolization, multidetector CT and MR imaging were used to assess LV function, fi rst-pass perfusion, and delayed contrast enhancement in remote myocardium and microinfarct scars. Histochemical staining with triphenyltetrazolium chloride (TTC) was used to confi rm and quantify heterogeneous microinfarct scars. The two-tailed Wilcoxon signed rank test was used to detect differences between modalities and myocardial regions. Results:The LAD territory was 32.4% 6 3.8 (stadard error of the mean) of the LV mass. Multidetector CT and MR imaging have similar sensitivity in the detection of regional and global LV dysfunction and extent of microinfarct. The mean LV end-diastolic volume, end-systolic volume, and ejection fraction were 93 mL 6 8, 46 mL 6 4, and 50% 6 3, respectively, on multidetector CT images and 92 mL 6 8, 48 mL 6 5, and 48% 6 3, respectively, on MR images ( P Ն .05). The extent of heterogeneous microinfarct was not significantly different between multidetector CT (6.3% 6 0.8 of the LV mass), MR imaging (6.6% 6 0.5 of the LV mass), and TTC staining (7.0% 6 0.6 of the LV mass). First-pass multidetector CT and MR imaging demonstrated signifi cant regional differences ( P , .05) in time to peak between the heterogeneous microinfarct and remote myocardium (17.0 seconds 6 0.3 and 12.4 seconds 6 0.6, respectively, for multidetector CT and 17.2 seconds 6 0.8 and 12.5 seconds 6 1.0 , respectively, for MR imaging). Conclusion:Modern multidetector CT and MR imaging are sensitive modalities with which to depict heterogeneous microinfarcts and determine regional LV dysfunction and decreased perfusion in the territory of intervention.q RSNA, 2010

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Section: Experimental Studies: Heterogeneous Microinfarcts Caused By supporting

confidence: 84%

Heterogeneous Microinfarcts Caused by Coronary Microemboli: Evaluation with Multidetector CT and MR Imaging in a Swine Model

Carlsson

Saloner²,

Martin³

et al. 2010

Radiology

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show abstract

“…They performed only thrombus aspiration to 2 cases and aspiration with subsequent stenting to 1 case successfully (3). A small number of case reports demonstrated AMI due to CE in patients with valvular prosthesis (4)(5)(6)(7)(8)(9). In a case with mitral valve prosthesis and AMI due to CE, Doğan et al (4) performed thrombolytic therapy with tissue plasminogen activator successfully.…”

Section: Discussionmentioning

confidence: 99%

“…In another report, thrombotic occlusion of LAD in a patient with aortic valve prosthesis was treated successfully with balloon dilatation and stenting by Kiernan et al (6). Besides the invasive strategy and thrombolysis, glycoprotein IIb-IIIa inhibitors and bivaluridin infusions were tried as treatment modalities (7)(8)(9). Previous reports demonstrated hemodynamically stable cases in which embolic masses were located in LAD and RCA.…”

Section: Discussionmentioning

confidence: 99%

Thrombotic occlusion of a left main coronary artery in a patient with prosthetic mitral valve

Saygı¹,

Alioğlu²,

Türk³

et al. 2010

Anadolu Kardiyol Derg

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“…Quinn et a! [10] have reported a case of a 63 year old lady with a 5t jude aortic and mitral valve replacement who presented with an acute myocardial infarction. Urgent catheterization revealed a saddle embolus in the circumflex and ramus arteries and another embolus in the diagonal branch.…”

Section: Discussionmentioning

confidence: 99%

Acute Myocardial Infarction in a Young Patient of Rheumatic Heart Disease

Raj¹,

Rk²

2011

Medical Journal Armed Forces India

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Coronary embolism following aortic and mitral valve replacement: Successful management with abciximab and urokinase

Cited by 30 publications

References 7 publications

Heterogeneous Microinfarcts Caused by Coronary Microemboli: Evaluation with Multidetector CT and MR Imaging in a Swine Model

Heterogeneous Microinfarcts Caused by Coronary Microemboli: Evaluation with Multidetector CT and MR Imaging in a Swine Model

Thrombotic occlusion of a left main coronary artery in a patient with prosthetic mitral valve

Acute Myocardial Infarction in a Young Patient of Rheumatic Heart Disease

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