Right Coronary Artery to Left Ventricular Fistula Complicated by Symptomatic Arrhythmia.

Coronary cameral fistulas (CCFs) are rare and are characterized by an abnormal connection between a coronary artery and any of the four chambers of the heart. Most cases of CCFs are asymptomatic. The most common presentation in symptomatic patients includes chest pain or heart failure; however, arrhythmias are rarely associated.

Tacrolimus-Induced Diffuse Coronary Artery Spasm.

Prinzmetal angina, also known as vasospastic angina, is defined as an intermittent focal or diffuse coronary artery narrowing, which is often associated with transient ST-segment elevation on an electrocardiogram. Also, it could be associated with an atherosclerotic lesion at the site of the spasm. Vasospastic angina might be induced by medications, most commonly with cocaine and other examples which include catecholamines such as epinephrine, norepinephrine, isoproterenol, dopamine, and dobutamine.

Self-Expandable Transcatheter Aortic Valve Implantation Outcomes: Findings From the Western Region of Saudi Arabia.

Background and objective The prevalence of aortic stenosis in Saudi Arabia is expected to increase owing to the rise in the life expectancy of the population. Such increase is expected to be met with higher demand for interventions including transcatheter aortic valve implantation (TAVI). In this study, we aimed to identify the outcomes of this procedure among the population of the Western region of Saudi Arabia.

The pulmonary vascular bed in patients with functionally univentricular physiology and a Fontan circulation.

Fontan palliation represents one of the most remarkable surgical advances in the management of individuals born with functionally univentricular physiology. The operation secures adult survival for all but a few with unfavourable anatomy and/or physiology. Inherent to the physiology is passive transpulmonary blood flow, which produces a vulnerability to adequate filling of the systemic ventricle at rest and during exertion.

The Adult Patient with a Fontan.

The authors summarize the most important anatomic and physiologic substrates of Fontan circulation. Common anatomic substrates include hypoplastic left heart syndrome, tricuspid atresia, double inlet left ventricle, and unbalanced atrioventricular septal defects. After the Fontan operation exercise capacity is limited and the key hemodynamic drivers is limited preload due to a relatively fixed pulmonary vascular resistance.

Percutaneous Device Closure of Patent Ductus Arteriosus in Adult Patients with 10-Year Follow-up.

Objectives: We report our 10-year experience with transcatheter closure of patent ductus arteriosus (PDA) in adult using different closure devices.

Background: Transcatheter closure of PDA in adults can be challenging because of frequently associated comorbidities. Reports on immediate and intermediate-term results of PDA closure are excellent.

ST-Segment Elevation Myocardial Infarction: Door to Balloon Time Improvement Project.

Background: The purpose of this quality improvement project was to evaluate prospectively the causes of delay for patients with acute ST-segment elevation myocardial infarction (STEMI) requiring primary percutaneous coronary intervention (PCI) upon arrival at the emergency department (ED) and implement recommendations to reduce delays and analyze the impact of recommendations to reduce the door-to-balloon (D2B) time in a newly established cardiac center (King Faisal Cardiac Center (KFCC)). Primary PCI has developed as an effective treatment strategy for acute STEMI, the survival rate and patient outcome are however dependent on the time to treatment. The international benchmark for all programs dealing with acute coronary syndrome patients suffering from STEMI has been established as 90 minutes or less from the time the patient arrives at the hospital to the opening of the affected vessel in the cardiac catheterization laboratory "door-to-balloon time" or D2B.

Cardiac resynchronization therapy in adults with congenital heart disease.

Aims: In adults with congenital heart disease (CHD) heart failure is one of the leading causes of morbidity and mortality but experience with and reported outcome of cardiac resynchronization therapy (CRT) is limited. We investigated the efficacy of CRT in adults with CHD.

Methods And Results: This was a retrospective study including 48 adults with CHD who received CRT since 2003 in four tertiary referral centres.

Long-term outcomes after percutaneous intervention of the internal thoracic artery anastomosis: the use of drug-eluting stents is associated with a higher need of repeat revascularization.

Background: There is a lack of data and absence of clear recommendations regarding the optimal treatment of lesions located at the anastomosis of internal thoracic artery (ITA) grafts and native coronary arteries (CAs). The objective of this study was to assess the long-term outcomes of percutaneous coronary intervention (PCI) at the ITA anastomosis according to delivered treatment, namely deployment of a drug-eluting stent (DES), bare-metal stent (BMS), or balloon angioplasty only (POBA).

Methods: We used a prospective PCI registry at a large Canadian teaching hospital to identify all patients who underwent PCI at the ITA-CA anastomosis between June 2000 and June 2010.

Use of clopidogrel post-coronary artery bypass surgery in canadian patients with acute coronary syndromes.

Background: Randomized trials have established the efficacy of clopidogrel in acute coronary syndromes (ACS). The benefit of clopidogrel has also been observed in the subgroup of ACS patients who subsequently undergo coronary artery bypass surgery (CABG); however, this therapy is discontinued preoperatively and the frequency with which clopidogrel is restarted post-CABG is unknown.

Methods: We examined the pattern of clopidogrel use in the Canadian Global Registry of Acute Coronary Events (GRACE), GRACE2, and CANRACE (2003-2008) post-CABG ACS patients.