BMJ case reports
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Case Reports
Platypnea-orthodeoxia syndrome related to right hemidiaphragmatic elevation and a 'stretched' patent foramen ovale.
Patent foramen ovale (PFO), although frequently observed in adults, rarely causes adverse clinical consequences. The most serious among them, are cryptogenic strokes and less commonly significant hypoxia resulting from right-to-left shunt (RLS). ⋯ The RLS was associated with right hemidiaphragmatic elevation, without an increased interatrial pressure gradient. The patient was successfully weaned from the ventilator after the percutaneous closure of PFO through a catheter-deployed double-umbrella device, presenting a full recovery.
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We present a case of a 43-year-old woman who presented with a non-ST elevation myocardial infarction. During her first cardiac catheterisation, she was diagnosed with a chronic total occlusion of the right coronary artery and a flow limiting dissection of her middle left anterior descending artery. The dissection of the left anterior descending artery was stented with two overlapping everolimus-eluting stents. ⋯ It was then found that the patient had a total occlusion of the right coronary artery secondary to dissection. This was also stented with three everolimus-eluting stents with excellent clinical and angiographic results. It is important to consider spontaneous multivessel coronary dissections which can be treated successfully with percutaneous coronary intervention.
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Case Reports
Incidentally detected Monckeberg's sclerosis in a diabetic with coronary artery disease.
We report the case of a 62-year-old diabetic man, who was incidentally detected to have extensive calcification in his upper limb arteries, consistent with Monckeberg's sclerosis. The condition was identified when routine radial puncture attempted in the course of coronary angiography was repeatedly unsuccessful. ⋯ Monckeberg's sclerosis is a poorly understood condition associated with generalised atherosclerosis and chronic kidney disease. The pathogenesis and natural history of Monckeberg's sclerosis are briefly discussed.