The Journal of invasive cardiology
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Fistulas between coronary artery and bronchial artery may be present from birth, with few hemodynamic consequences, and may remain closed due to similarity of the filling pressures at these 2 sites. They can also be secondary to pulmonary artery occlusive disease or chronic pulmonary inflammation. These pulmonary changes may cause a dilation of the fistula and make it functional, causing angina pectoris by coronary steal syndrome, which is the most common symptom. ⋯ However, most patients remain asymptomatic. The ones that need treatment may not have a good response to the medical management, requiring an intervention. This can be done using embolization coils, stents grafts, and performing surgical ligation of the fistulas.
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We present a case of left atrial sarcoma presenting as acute myocardial infarction. Echocardiographic finding of left atrial mass, absence of angiographic evidence of coronary atherosclerotic disease, and incidental finding of prior splenic infarct strongly point to coronary emboli. The relatively low incidence of cardiac sarcoma and the uncommon presentation of cardiac sarcoma as myocardial infarction make this case unique.
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The recent development of transcatheter aortic valve implantation (TAVI) for patients with severe aortic stenosis (AS) offers a feasible option for high-risk surgical patients. However, several complications are specifically related to this technique. The present case describes a novel complication associated with TAVI, a severe paravalvular leak related to "stretch-induced" peri-aortic hematoma. The possible mechanisms of this complication, as well as its potential solutions, are discussed.
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A 68-year-old African American female with a prior medical history of hypertension and dyslipidemia presented with sudden onset pressure-like substernal chest pain. Initial ECG showed no ST or T wave abnormalities, and troponin elevation of 2.88 ng/mL. ⋯ We successfully treated with balloon angioplasty followed by placement of 3 drug-eluting stents resulting in TIMI-3 flow; further testing for vasculitis was negative. Once spontaneous coronary artery dissection is diagnosed, the approach to treatment is controversial and treatment should be patient tailored.