scholarly journals Left Ventricular Summit—Concept, Anatomical Structure and Clinical Significance

Diagnostics ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 1423
Author(s):  
Marcin Kuniewicz ◽  
Artur Baszko ◽  
Dyjhana Ali ◽  
Grzegorz Karkowski ◽  
Marios Loukas ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Cardiac Computed Tomography ◽  
Nerve Fibers ◽  
Left Ventricular ◽  
Autonomic Nerve ◽  
Radiofrequency Energy ◽  
Circumflex Artery ◽  
Left Circumflex Artery ◽  
Electrophysiological Procedures ◽  
Septal Perforator

The left ventricular summit (LVS) is a triangular area located at the most superior portion of the left epicardial ventricular region, surrounded by the two branches of the left coronary artery: the left anterior interventricular artery and the left circumflex artery. The triangle is bounded by the apex, septal and mitral margins and base. This review aims to provide a systematic and comprehensive anatomical description and proper terminology in the LVS region that may facilitate exchanging information among anatomists and electrophysiologists, increasing knowledge of this cardiac region. We postulate that the most dominant septal perforator (not the first septal perforator) should characterize the LVS definition. Abundant epicardial adipose tissue overlying the LVS myocardium may affect arrhythmogenic processes and electrophysiological procedures within the LVS region. The LVS is divided into two clinically significant regions: accessible and inaccessible areas. Rich arterial and venous coronary vasculature and a relatively dense network of cardiac autonomic nerve fibers are present within the LVS boundaries. Although the approach to the LVS may be challenging, it can be executed indirectly using the surrounding structures. Delivery of the proper radiofrequency energy to the arrhythmia source, avoiding coronary artery damage at the same time, may be a challenge. Therefore, coronary angiography or cardiac computed tomography imaging is strongly recommended before any procedure within the LVS region. Further research on LVS morphology and physiology should increase the safety and effectiveness of invasive electrophysiological procedures performed within this region of the human heart.

scholarly journals Left ventricular summit -- concept, anatomical description and clinical significance

2021 ◽  
Author(s):  
Marcin Kuniewicz ◽  
Artur Baszko ◽  
Mateusz Holda ◽  
Dyjhana Ali ◽  
Grzegorz Karkowski ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Cardiac Computed Tomography ◽  
Nerve Fibers ◽  
Left Ventricular ◽  
Autonomic Nerve ◽  
Radiofrequency Energy ◽  
Circumflex Artery ◽  
Left Circumflex Artery ◽  
Electrophysiological Procedures ◽  
Septal Perforator

The left ventricular summit (LVS) is a triangular area located at the most superior portion of the left epicardial ventricular region, surrounded by the two branches of the left coronary artery: the left anterior interventricular artery and the left circumflex artery. The triangle is bounded by the apex, septal and mitral margins and base. This review aims to provide a systematic and comprehensive anatomical description and proper terminology in the LVS region that may facilitate exchanging information among anatomists and electrophysiologists, increasing knowledge of this cardiac region. We postulate that the most dominant septal perforator (not the first septal perforator) should characterize the LVS definition. Abundant epicardial adipose tissue overlying the LVS myocardium may affect arrhythmogenic processes and electrophysiological procedures within the LVS region. The LVS is divided into two clinically significant regions: accessible and inaccessible areas. Rich arterial and venous coronary vasculature and a relatively dense network of cardiac autonomic nerve fibers are present within the LVS boundaries. Although the approach to the LVS may be challenging, it can be executed indirectly using the surrounding structures. Delivery of the proper radiofrequency energy to the arrhythmia source, avoiding coronary artery damage at the same time, may be a challenge. Therefore, coronary angiography or cardiac computed tomography imaging is strongly recommended before any procedure within the LVS region. Further research on LVS morphology and physiology should increase the safety and effectiveness of invasive electrophysiological procedures performed within this region of the human heart. Published in Diagnostics: https://doi.org/10.3390/diagnostics11081423

scholarly journals Case Report: Transcatheter Aortic Valve Replacement in a Patient With Severe Aortic Stenosis, Left Ventricular Dysfunction, and an Anomalous Left Circumflex Artery

2021 ◽  
Vol 8 ◽  
Author(s):  
Badreyah Aldauig ◽  
Mohammed El-Sabbah ◽  
Mirvat Alasnag
Keyword(s):  
Case Report ◽  
Aortic Valve ◽  
Severe Aortic Stenosis ◽  
Cardiac Computed Tomography ◽  
Fusion Imaging ◽  
Left Ventricular ◽  
Circumflex Artery ◽  
Left Circumflex Artery ◽  
Transcatheter Aortic Valve ◽  
Complex Structural

The role of cardiac computed tomography in the evaluation of patients for transcatheter aortic valve implantation is well-established. However, its role in the evaluation of anomalous vessels in the pre-procedure planning, intra-procedural fusion imaging and post-procedure assessment of vessel patency is not yet defined. This case report illustrates the utility of cardiac CT throughout the management of complex structural interventions. Here, we describe an anomalous left coronary artery where the course of the anomalous vessel and its proximity to the aortic valve annulus is defined allowing the selection of the most appropriate balloon expandable valve with a planned deployment. Upon follow up, patency of this anomalous vessel is ascertained using CT as well as the transcatheter valve function and leaflet thickening.

scholarly journals Case Report: Cardiac arrest due to traumatic coronary artery dissection treated by extracorporeal membrane resuscitation

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 1720
Author(s):  
Kumiko Tanaka ◽  
Taka-aki Nakada ◽  
Tadayuki Kadohira ◽  
Shigeto Oda
Keyword(s):  
Cardiac Arrest ◽  
Coronary Artery ◽  
Cardiopulmonary Resuscitation ◽  
Spontaneous Circulation ◽  
Left Ventricular ◽  
Artery Dissection ◽  
Coronary Artery Dissection ◽  
Circumflex Artery ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Left Circumflex Artery

Traumatic coronary artery dissection, which is rare in blunt trauma, has high risk of acute myocardial infarction and cardiac arrest. A 44-year-old man who had a traffic accident was transferred to the emergency department with refractory ventricular fibrillation (VF). After conventional cardiopulmonary resuscitation, we introduced extracorporeal cardiopulmonary resuscitation (ECPR) and obtained return of spontaneous circulation with ST-elevation electrocardiogram at V4-6. Subsequent coronary angiography and intravascular ultrasound supported by extracorporeal membrane oxygenation (ECMO) revealed complete occlusions of left anterior descending and left circumflex artery due to dissections. Drug-eluting stents were placed with restorations of TIMI 2 flows. After ICU admission, his left ventricular function gradually recovered; he was successfully weaned from VA-ECMO on day 9. ECPR may be a valuable option to allow time and stable hemodynamic condition to treat the cause of cardiac arrest.

scholarly journals Three broken vessels in a peripartum patient: a rare case report of spontaneous triple vessel coronary artery dissection

2020 ◽  
Vol 4 (5) ◽  
pp. 1-6
Author(s):  
Hassan Lak ◽  
Karim Abdul Rehman ◽  
Wael A Jaber ◽  
Leslie Cho
Keyword(s):  
Coronary Artery ◽  
Troponin I ◽  
Significant Risk ◽  
Left Ventricular ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Circumflex Artery ◽  
Left Circumflex Artery ◽  
Coronary Syndrome

Abstract Background Spontaneous coronary artery dissection (SCAD) is a frequently underdiagnosed entity that carries a significant risk of morbidity and mortality. Spontaneous coronary artery dissection is increasingly recognized as an important cause of acute coronary syndrome (ACS) and, the majority of SCAD patients are young healthy women. Case summary A 23-year-old female G5P4 presented to the emergency room for severe sub-sternal chest pain, associated with shortness of breath. Past medical history was significant for pre-eclampsia. Initial electrocardiogram was remarkable for ST depressions in V5–V6 with inverted T waves to V1–V2. Troponin I was elevated to 1.13 ng/mL. Two-dimensional echo showed reduced left ventricular function with an ejection fraction of 40%. Cardiac catheterization showed triple vessel dissection involving the left main trunk extending into mid-left anterior descending and dissection extending from ostium of left circumflex artery into large first obtuse marginal branch. She was started on aspirin and heparin. After 48 h she was loaded with clopidogrel. Computed tomography angiography of head, neck, abdomen, and pelvis showed findings compatible with fibromuscular dysplasia. She was haemodynamically stable and symptom free and did not want surgery. She was recommended to continue dual antiplatelet therapy for 12 months and subsequently aspirin and beta blocker only lifelong. Discussion Spontaneous coronary artery dissection is a rare condition which is underdiagnosed. A thorough history and high degree of suspicion is required to diagnose in a timely manner and it should be high on differential in a postpartum female presenting with signs and symptoms of ACS.

Effects of pericardial pressure on systemic and coronary hemodynamics in dogs

1995 ◽  
Vol 268 (4) ◽  
pp. H1593-H1605 ◽  
Author(s):  
F. L. Abel ◽  
L. S. Mihailescu ◽  
A. S. Lader ◽  
R. G. Starr
Keyword(s):  
Coronary Artery ◽  
Vascular Resistance ◽  
Characteristic Impedance ◽  
Left Ventricular ◽  
Coronary Vascular Resistance ◽  
Circumflex Artery ◽  
Left Circumflex Artery ◽  
Group A ◽  
Pericardial Pressure ◽  
Group B

The effects of pericardial tamponade on coronary capacitance and coronary systemic hemodynamics were calculated in two groups of animals subjected to increases in pericardial pressure (PCP) up to approximately 20 mmHg. In one group (A), flow in the left circumflex artery was measured in the intact animal under conditions of increased PCP. In the second group (B), coronary artery perfusion pressure was maintained constant with a pump while PCP was increased. In group A increased PCP was accompanied by a decrease in arterial pressure. This resulted in a marked decrease in coronary blood flow after vasodilation but without a change in coronary vascular resistance. In group B there was no change in coronary flow or coronary vascular resistance with increased PCP. Microsphere distribution to the left ventricular wall showed less endocardial than epicardial flow but no change in going from low to high PCP. Characteristic impedance was altered in the group B animals after vasodilation at medium and high PCP, indicating a loss of reflection sites and probably increased vessel tethering. The coronary artery in a subgroup of group B animals was also perfused by left ventricular pressure, the time constants for coronary backflow showing an 8–12% decrease in capacitance with low and high PCP; these values represent minimal epicardial capacitances vs. total bed capacitance. A diastolic model for the values for resistance and capacitance in the coronary bed is suggested. As expected, most of the capacitance is in the venous bed and most of the resistance is in the arterial bed.

Prevalence and Localization of Hibernating Myocardium Among Patients with Left Ventricular Dysfunction

2019 ◽  
Vol 15 (9) ◽  
pp. 884-889
Author(s):  
Emine Acar ◽  
Ayşegül Aksu ◽  
Gökmen Akkaya ◽  
Gamze Çapa Kaya
Keyword(s):  
Scar Tissue ◽  
Left Ventricular ◽  
Hibernating Myocardium ◽  
Circumflex Artery ◽  
Irrigation Area ◽  
Left Circumflex Artery ◽  
Pet Ct ◽  
Perfusion Defects ◽  
The Right ◽  
Fdg Pet Ct

Objective: This study evaluated how much of the myocardium was hibernating in patients with left ventricle dysfunction and/or comorbidities who planned to undergo either surgical or interventional revascularization. Furthermore, this study also identified which irrigation areas of the coronary arteries presented more scar and hibernating tissue. Methods: At rest, Tc-99m MIBI SPECT and cardiac F-18 FDG PET/CT images collected between March 2009 and September 2016 from 65 patients (55 men, 10 women, mean age 64±12) were retrospectively analyzed in order to evaluate myocardial viability. The areas with perfusion defects that were considered metabolic were accepted as hibernating myocardium, whereas areas with perfusion defects that were considered non-metabolic were accepted as scar tissue. Results: Perfusion defects were observed in 26% of myocardium, on average 48% were associated with hibernation whereas other 52% were scar tissue. In the remaining Tc-99m MIBI images, perfusion defects were observed in the following areas in the left anterior descending artery (LAD; 31%), in the right coronary artery (RCA; 23%) and in the Left Circumflex Artery (LCx; 19%) irrigation areas. Hibernation areas were localized within the LAD (46%), LCx (54%), and RCA (64%) irrigation areas. Scar tissue was also localized within the LAD (54%), LCx (46%), and RCA (36%) irrigation areas. Conclusion: Perfusion defects are thought to be the result of half hibernating tissue and half scar tissue. The majority of perfusion defects was observed in the LAD irrigation area, whereas hibernation was most often observed in the RCA irrigation area. The scar tissue development was more common in the LAD irrigation zone.

Hypoplastic Left Circumflex Coronary Artery: Imaging Findings with Coronary Computed Tomography Angiography - A Case Report

2019 ◽  
Vol 15 (4) ◽  
pp. 427-429
Author(s):  
Asli Tanrivermis Sayit ◽  
Cetin Celenk
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Coronary Computed Tomography Angiography ◽  
Coronary Artery Imaging ◽  
Circumflex Coronary Artery ◽  
Circumflex Artery ◽  
Coronary Computed Tomography ◽  
True Incidence ◽  
Left Circumflex Artery ◽  
Artery Disease

<P>Background: Hypoplastic coronary artery disease is a rare congenital coronary artery anomaly. It is often detected incidentally, and its true incidence in the general population is not known. </P><P> Discussion: Symptoms of HCAD are syncope, palpitations, dyspnea, and chest pain. Also, arrhythmia and myocardial infarction can be seen; these can cause sudden death, especially in athletes and young people. Diagnosis is often made at autopsy. Conclusion: Here, we present the case of a 39-year-old male with isolated hypoplasia of the left circumflex artery detected by coronary Computed Tomography (CT) angiography who complained of palpitation.</P>

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