IMAGING IN CARDIOLOGY
Acute anteroseptal myocardial infarction
E.A. van Beek, A.J.M. Oude Ophuis
A 45-year old man was referred to our hospital with an acute anteroseptal myocardial infarction. Because of a car accident a few days before admission no thrombolysis was given and primary coronary angioplasty was performed. After initial inflation in the stenosis with a 3.5 x 18 mm balloon, rupture of the coronary artery occurred at the distal end of the balloon. The balloon was reinflated to stop the bleeding temporaryly. A Jostent GraftMaster with Hydrex Coating system 3.0 x 19 mm was implanted and successfully sealed off the ruptured coronary vessel wall. It is possible that the occlusion of the left anterior descending artery was caused by the car accident. Coronary artery occlusion is a rare complication of blunt chest trauma. The left anterior descending artery is the injured vessel in 76%, followed by the right coronary artery (12%) and the circumflex coronary artery (6%).' Most likely the occlusion is a thrombotic response to an intimal tear caused by the trauma.2
Fukutomi et al. find 69 coronary perforations in 7443 PCI's. 18 have a jet of contrast extravasation and those were all treated by prolonged perfusion balloon angioplasty. 2 required emergency coronary artery E.A. van Book Department of Cardiology, Nijmegen University Medical Centre,
Nijmegen A.J.M. Oude Ophuls Department of Cardiology, Canisius Wilhelmina Medical Centre, Nimegen
Correspondence to: E.A. van Beek Department of Cardiology, Nijmegen University Medical Centre, Nijmegen E-mail: [email protected]
508
Figure 1. Left anterior oblique view of the left anterior descending artery. Clearly visible is the bilateral outflow of contrast in the middle segment.
bypass surgery and 72,2% developed late pseudoaneurysms within one year but without consequences.3 The incidence is low, 0,1-0,2% with balloon angioplasty alone but when atherectomy devices are used the incidence rises to 2%.4 Smaller perforations like most guidewire perforations may be treated with observation or prolonged balloon inflation. Larger perforations require quick balloon tamponade before other treatments are performed, for example reversal of anticoagulation, intravenous fluids, pericardiocentesis, surgical exploration or covered stents.5 Pericardiocentesis should be performed only in
Netherlands Heart Journal, Volume 12, Number 11, November 2004
IMAGING IN CARDIOLOGY
hemodynamic unstable patients rather than on a prophylactic basis. References 1 2
3 4
5
Ginzburg E, Dygert J, Parra-Davila E, Lynn M, Almeida J, Mayor M. Coronary artery stenting for occlusive dissection after blunt chest trauma. J Trauma 1998;45:157-61. Oren A, Bar-Sholomo B, Stern S. Acute coronary occlusion following blunt injury to the chest in the absence of coronary atherosclerosis. Am HeartJ1976;92:501-5. Fukutomi T, Suzuki T, Popma JJ, et al. Early and late clinical outcomes following coronary perforation in patients undergoing percutaneous coronary intervention. CircJ2002;66(4):349-56. Ellis SG, S Ajluni, AZ Arnold, et al: Increased coronary perforation in the new device era: incidence, classification, management, and outcome. Circulation 1994;90:2725-30. Gruberg L, E Pinnow, RFlood, et al. Incidence, management, and outcome of coronary artery perforation during percutaneous coronary intervention. American Journal of Cardiology 2000; 86:680-2.
:'..' ....::.....
Tesmview a,'e th coated Sten Figure 2....
was
pl'ed
In this section a remarkable 'image' is presented and a short comment is given. We invite you to send in images (in triplicate) with a short comment (one to two pages at the most) to Mediselect bv, Editorial Office Netherlands Heart Journal, PO Box 63, 3830 AB Leusden, the Netherlands. This section is edited by M.J.M. Cramer andj. Bax.
Productinformatie van de in dit tijdschrift opgenomen advertenties Referenties: 1. Sega R., et al. Efficacy and safety of eprosartan in severe hypertension. Blood Pressure 1999; 8: 114-121. 2. Sachse et al. Efficacy of eprosatan in combination with HCTZ in patents with essential hypertension. J of Human Hypertension, 2002, 16: 169-176.
TTEiV
eprosartan
W1 7ETENPPLUS - rtn hydro.hlo-thi-id. e~~~~~~~~pr
Samenstelling: Teveten' bevat eprosartan mesylaat overeenkomend met 400 of 600 mg eprosartan (als vfije base) per tablet. TevetenrPlus bevat eprosartan mesylaat overeenkomend met 600 mg eprosartan (als vfije base) per tablet en 12,5 mg hydrochloorthiazide. Parmacotherapeutische groep: Teveten: Angiotensine II receptor antagonist. Teveten'Plus: Combinatie van een Anrgiotensine II receptor antagonist en een thiazidediureticum. Indicatie: Teveten': Essentiele hypertensie. TevetenPPlus: Behandeling van patienten met essentiele hypertensie die onvoldoende hebben gereageerd op behandeling met een Allreceptorantagonist als monotherapie. Dosering: Teveten 600 mg eenmaal daags. Wanneer de daling van de bloeddruk onvoldoende is, kan de dosis worden verhoogd tot 800 mg, of kan een ander antihypertensivum worden toegevoegd (zoals thazide-diureticum of calciumblokker). TevetenPl us: 1 maal daags 1 tablet. Teveten, Plus kan alleen of in combinatie met andere antihypertensiva worden gebruikt als een sterker bloeddruk vedagend effect gewenst is. Inname met of zonder voedsel. Contra-indicaties: Teveten: gebleken overgevoeligheid voor een der bestanddelen van het product. Zwangerschap en lactatie. Emstig verminderde leverfunctie. Teveten'Plus: Als Teveten' en gebleken overgevoeligheid voor sulfonamidederivaten en emstig venninderde nierfunctie (aeatinineklaring f 30 m/min.). Speciale waarschuwingen en voorzorgen:Teveten: Niet aanbevolen bij emstig gestoorde nierfunctie (creatineklaring
Acute anteroseptal myocardial infarction
E.A. van Beek, A.J.M. Oude Ophuis
A 45-year old man was referred to our hospital with an acute anteroseptal myocardial infarction. Because of a car accident a few days before admission no thrombolysis was given and primary coronary angioplasty was performed. After initial inflation in the stenosis with a 3.5 x 18 mm balloon, rupture of the coronary artery occurred at the distal end of the balloon. The balloon was reinflated to stop the bleeding temporaryly. A Jostent GraftMaster with Hydrex Coating system 3.0 x 19 mm was implanted and successfully sealed off the ruptured coronary vessel wall. It is possible that the occlusion of the left anterior descending artery was caused by the car accident. Coronary artery occlusion is a rare complication of blunt chest trauma. The left anterior descending artery is the injured vessel in 76%, followed by the right coronary artery (12%) and the circumflex coronary artery (6%).' Most likely the occlusion is a thrombotic response to an intimal tear caused by the trauma.2
Fukutomi et al. find 69 coronary perforations in 7443 PCI's. 18 have a jet of contrast extravasation and those were all treated by prolonged perfusion balloon angioplasty. 2 required emergency coronary artery E.A. van Book Department of Cardiology, Nijmegen University Medical Centre,
Nijmegen A.J.M. Oude Ophuls Department of Cardiology, Canisius Wilhelmina Medical Centre, Nimegen
Correspondence to: E.A. van Beek Department of Cardiology, Nijmegen University Medical Centre, Nijmegen E-mail: [email protected]
508
Figure 1. Left anterior oblique view of the left anterior descending artery. Clearly visible is the bilateral outflow of contrast in the middle segment.
bypass surgery and 72,2% developed late pseudoaneurysms within one year but without consequences.3 The incidence is low, 0,1-0,2% with balloon angioplasty alone but when atherectomy devices are used the incidence rises to 2%.4 Smaller perforations like most guidewire perforations may be treated with observation or prolonged balloon inflation. Larger perforations require quick balloon tamponade before other treatments are performed, for example reversal of anticoagulation, intravenous fluids, pericardiocentesis, surgical exploration or covered stents.5 Pericardiocentesis should be performed only in
Netherlands Heart Journal, Volume 12, Number 11, November 2004
IMAGING IN CARDIOLOGY
hemodynamic unstable patients rather than on a prophylactic basis. References 1 2
3 4
5
Ginzburg E, Dygert J, Parra-Davila E, Lynn M, Almeida J, Mayor M. Coronary artery stenting for occlusive dissection after blunt chest trauma. J Trauma 1998;45:157-61. Oren A, Bar-Sholomo B, Stern S. Acute coronary occlusion following blunt injury to the chest in the absence of coronary atherosclerosis. Am HeartJ1976;92:501-5. Fukutomi T, Suzuki T, Popma JJ, et al. Early and late clinical outcomes following coronary perforation in patients undergoing percutaneous coronary intervention. CircJ2002;66(4):349-56. Ellis SG, S Ajluni, AZ Arnold, et al: Increased coronary perforation in the new device era: incidence, classification, management, and outcome. Circulation 1994;90:2725-30. Gruberg L, E Pinnow, RFlood, et al. Incidence, management, and outcome of coronary artery perforation during percutaneous coronary intervention. American Journal of Cardiology 2000; 86:680-2.
:'..' ....::.....
Tesmview a,'e th coated Sten Figure 2....
was
pl'ed
In this section a remarkable 'image' is presented and a short comment is given. We invite you to send in images (in triplicate) with a short comment (one to two pages at the most) to Mediselect bv, Editorial Office Netherlands Heart Journal, PO Box 63, 3830 AB Leusden, the Netherlands. This section is edited by M.J.M. Cramer andj. Bax.
Productinformatie van de in dit tijdschrift opgenomen advertenties Referenties: 1. Sega R., et al. Efficacy and safety of eprosartan in severe hypertension. Blood Pressure 1999; 8: 114-121. 2. Sachse et al. Efficacy of eprosatan in combination with HCTZ in patents with essential hypertension. J of Human Hypertension, 2002, 16: 169-176.
TTEiV
eprosartan
W1 7ETENPPLUS - rtn hydro.hlo-thi-id. e~~~~~~~~pr
Samenstelling: Teveten' bevat eprosartan mesylaat overeenkomend met 400 of 600 mg eprosartan (als vfije base) per tablet. TevetenrPlus bevat eprosartan mesylaat overeenkomend met 600 mg eprosartan (als vfije base) per tablet en 12,5 mg hydrochloorthiazide. Parmacotherapeutische groep: Teveten: Angiotensine II receptor antagonist. Teveten'Plus: Combinatie van een Anrgiotensine II receptor antagonist en een thiazidediureticum. Indicatie: Teveten': Essentiele hypertensie. TevetenPPlus: Behandeling van patienten met essentiele hypertensie die onvoldoende hebben gereageerd op behandeling met een Allreceptorantagonist als monotherapie. Dosering: Teveten 600 mg eenmaal daags. Wanneer de daling van de bloeddruk onvoldoende is, kan de dosis worden verhoogd tot 800 mg, of kan een ander antihypertensivum worden toegevoegd (zoals thazide-diureticum of calciumblokker). TevetenPl us: 1 maal daags 1 tablet. Teveten, Plus kan alleen of in combinatie met andere antihypertensiva worden gebruikt als een sterker bloeddruk vedagend effect gewenst is. Inname met of zonder voedsel. Contra-indicaties: Teveten: gebleken overgevoeligheid voor een der bestanddelen van het product. Zwangerschap en lactatie. Emstig verminderde leverfunctie. Teveten'Plus: Als Teveten' en gebleken overgevoeligheid voor sulfonamidederivaten en emstig venninderde nierfunctie (aeatinineklaring f 30 m/min.). Speciale waarschuwingen en voorzorgen:Teveten: Niet aanbevolen bij emstig gestoorde nierfunctie (creatineklaring
