Publications (11)12.12 Total impact
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Article: Coronary Extramural Haematoma Caused by Perforation during Left Main Coronary Artery Intervention.
Heart Lung & Circulation 04/2013; · 1.20 Impact Factor -
Article: Right posterior sinoatrial node artery showing a pericaval course: a previously undescribed mode of termination
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ABSTRACT: The left posterior sinus node artery (PSNA) originates from the posterolateral left circumflex artery, is quite common and shows more frequently a retrocaval mode of termination. In contrast, the right PSNA that arises from the terminal right coronary artery has been rarely described while information on its mode of termination is generally lacking. The PSNA courses close to the ostia of the superior pulmonary veins; hence, it may get injured during surgical or catheter ablation procedures performed for the treatment of atrial fibrillation. The left PSNA terminates retrocavally more frequently than the usual SNAs; hence, it may be at a greater risk of transection during the popular superior septal approach to the mitral valve. We present a case of right PSNA which terminated in a previously unreported course, i.e., the pericaval. Discussion pertains to the anatomic features of the PSNA that render it susceptible to the aforementioned complications. KeywordsSinoatrial node artery-S-shaped sinus node artery-Cavoatrial junction-Superior septal incision-AF ablation-Pulmonary vein isolationSurgical and Radiologic Anatomy 04/2012; 32(6):609-612. · 1.06 Impact Factor -
Article: A case of crossing coronary arteries.
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ABSTRACT: We present the case of a patient in whom coronary angiography, performed due to severe calcific aortic stenosis, revealed crossing between the left anterior descending artery and the first diagonal branch. There is only a single report presenting this particular coronary anatomy, whereas this is the eleventh case of crossing coronary arteries ever reported. The clinical implications of this variant coronary anatomy with regard to diagnostic angiography and selection of revascularization procedures are briefly discussed.Journal of Cardiovascular Medicine 03/2012; 13(5):332-3. · 1.51 Impact Factor -
Article: A patient with multiple vascular atherosclerotic distributions.
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ABSTRACT: The present report describes a patient who experienced unstable angina late after coronary artery bypass surgery, in which the left internal mammary artery was grafted to the left anterior descending artery. Catheterization revealed the culprit, which was left main stem obstructive disease, a significant proximal left subclavian artery (SCA) lesion and a large abdominal aortic aneurysm. The latter lesions were not suspected or revealed before catheterization. Combined surgical management was recommended; however, the patient died following recurrent angina that was complicated with pulmonary edema and cardiac arrest. Patients with severe coronary artery disease are at high risk of having multiple vascular atherosclerotic distributions including SCA stenosis and abdominal aortic aneurysm. Recurrent angina after left internal mammary artery grafting should always raise the suspicion of a left SCA stenosis causing coronary subclavian steal. Such patients should undergo a comprehensive cardiovascular evaluation to reveal the extent of atherosclerotic disease. Such an approach affects decision making in the catheterization laboratory and aids in choosing the safest and most effective treatment for the individual patient.Experimental and clinical cardiology 01/2011; 16(1):27-9. · 0.58 Impact Factor -
Article: Preinfarction angina entailing precordial ST segment depression with positive T wave.
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ABSTRACT: In patients with rest angina, the ECG pattern of precordial ST segment depression with positive T wave has been correlated with a subtotal occlusion of the left anterior descending artery (LADA); it represents regional anterior wall subendocardial ischemia. We present a patient with preinfarction angina and this unusual ECG pattern in whom the culprit LADA lesion coexisted with a left circumflex artery lesion. The absence of ST segment elevation in the posterior leads or contractile abnormalities across the inferior-lateral wall precluded the latter lesion from being the culprit. The ST segment elevation recorded in leads III and aVF was ascribed to transmural ischemia across the apical LADA, likely due to distal embolization. This study highlights that awareness of this ECG pattern and its correlation with a culprit LADA lesion may facilitate avoiding the erroneous diagnosis of diffuse subendocardial ischemia in cases of rest angina and multivessel disease in which the precordial T waves are negative.Journal of Cardiovascular Medicine 10/2010; 12(11):828-32. · 1.51 Impact Factor -
Article: Symptomatic anomalous right coronary artery originating superior to the left aortic sinus with interarterial course in a young adult. Diagnosis with multislice computed tomographic coronary angiography.
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ABSTRACT: Anomalous origination of a coronary artery from the opposite (improper) aortic sinus with an interarterial course comprises the group of coronary anomalies with the greatest risk for sudden cardiac death (SCD) in the young. SCD in such settings is consistently related with exercise and driven by ischemia. The proximal ectopic vessel is intussuscepted at the aortic wall and such an anatomy has been documented to be the culprit one. We present a 26-year-old male patient with exercise-induced angina and syncope due to an anomalous right coronary artery, which originated from the tubular ascending aorta superior to the left aortic sinus and followed an interarterial course. Diagnosis was reached with multislice computed tomographic (MSCT) coronary angiography. This case highlights the utility of MSCT to depict the ectopic coronary artery origin and course as well as the narrowed intussuscepted proximal ectopic segment.Journal of Cardiovascular Medicine 05/2010; 13(2):148-51. · 1.51 Impact Factor -
Article: Dual anterior interventricular artery type IV: a rare anatomical variation.
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ABSTRACT: Type IV dual anterior interventricular artery (AIVA) is a rare variant that involves bilateral connection of this vessel to the left main coronary artery and right coronary artery or right aortic sinus. We present a case of such a variant where the ectopic branch traveled an intraseptal course, i.e., through the superior aspect of the crista supraventricularis in a subendocardial position and then intramyocardially inside the upper interventricular septum to reach the anterior interventricular sulcus and descend toward the apex. In a left anterior oblique view, this course lacked the typical caudal anterior loop but it was recognized by virtue of emergence of a septal branch as the first branch of the ectopic AIVA. Recognition of this variant and differentiation among the possible courses of the ectopic branch is important for patient management.Anatomia Clinica 03/2010; 32(7):699-702. · 0.93 Impact Factor -
Article: Diffuse precordial ST-segment elevation in inferior-right myocardial infarction.
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ABSTRACT: A right ventricular (RV) myocardial infarction (MI) may yield precordial ST-segment elevation (STE). Accordingly, combined inferior and precordial STE may be produced during an inferior-RV MI. Such an electrocardiographic picture may be mistakenly regarded as showing wrapped left anterior descending artery (LADA) occlusion or double vessel occlusion. We present a patient with inferior-RV MI and STE in the inferior, all precordial and right chest leads, in whom the diffuse precordial STE was probably mistakenly regarded as showing anterior MI. However, the STE resolution in V1-V2 and late R' wave in V1, which were combined with a recanalized RV branch, favored the RV origin of this STE. Furthermore, the LADA was patent when V3-V6 showed severe ischemia, while its lesion was angiographically stable. Thus its simultaneous occlusion was unlikely. The late R' wave in V1 indicates RV transmural conduction delay;as highlighted herein, it is diagnostic of a RV myocardial infarction.Cardiology journal 01/2010; 17(6):628-31. · 1.31 Impact Factor -
Article: Short branch of type IV dual left anterior descending coronary artery running as an aberrant obtuse marginal branch: a previously undescribed arrangement.
Clinical Anatomy 04/2009; 22(8):873-5. · 1.29 Impact Factor -
Article: Aberrant right coronary artery origin from the left aortic sinus with interarterial course manifesting acute myocardial infarction.
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ABSTRACT: A 43-year-old patient was admitted to hospital because of an inferior-posterior myocardial infarction. The admission electrocardiogram was suggestive of a right coronary artery (RCA) culprit lesion. Coronary angiography following successful thrombolysis revealed a normal left system and mild intraluminal disease of the dominant RCA, which arose from the left aortic sinus and travelled an interarterial course; the latter was depicted in a subsequent computed tomographic angiogram. The lack of ST segment elevation in V4R and the absence of right ventricular wall motion abnormalities on echocardiography precluded the proximal ectopic vessel from being the culprit. The patient was managed medically; one year following discharge, he is asymptomatic. In cases of aberrant anomalous origin of a coronary artery from the opposite sinus with interarterial course, the proximal ectopic vessel is intussuscepted within the aortic wall, potentially leading to ischemia. The present article highlights that, although medical treatment in cases of such an aberrant RCA without apparent ischemia-driven sequelae may be valid, the need for interventional treatment could be substantiated following investigation of the anatomofunctional features of the intussuscepted proximal ectopic segment with intravascular ultrasound.Experimental and clinical cardiology 01/2009; 14(4):50-2. · 0.58 Impact Factor -
Article: Stenting for an internal mammary artery graft kink.
Archives of cardiovascular diseases 104(6-7):423-4. · 0.66 Impact Factor
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Institutions
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2009–2011
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Nicosia General Hospital
Nicosia, Nicosia District, Cyprus
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