{"title":"Discharge against medical advice in patients during the COVID-19 outbreak: Correspondence","authors":"P. Sookaromdee, V. Wiwanitkit","doi":"10.4103/rcm.rcm_60_21","DOIUrl":"https://doi.org/10.4103/rcm.rcm_60_21","url":null,"abstract":"","PeriodicalId":21031,"journal":{"name":"Research in Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49627685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Firouzi, S. Abdi, M. Alemzadeh-Ansari, Zahra Hosseini, Tayebe Gholizad, Amir Abdi, E. Khalilipur
In tanscatheter aortic valve replacement (TAVR) era, knowing complications related to the procedure guides interventional cardiologist in predicting the obstacles and helps them in manage these infirmities. We describe a case of TAVR which deploying the valve resulted in left ventricle outlet tract (LVOT) obstruction which was perfectly managed pacing and medical therapy.
{"title":"Migrating obstruction posttranscatheter aortic valve replacement","authors":"A. Firouzi, S. Abdi, M. Alemzadeh-Ansari, Zahra Hosseini, Tayebe Gholizad, Amir Abdi, E. Khalilipur","doi":"10.4103/rcm.rcm_68_21","DOIUrl":"https://doi.org/10.4103/rcm.rcm_68_21","url":null,"abstract":"In tanscatheter aortic valve replacement (TAVR) era, knowing complications related to the procedure guides interventional cardiologist in predicting the obstacles and helps them in manage these infirmities. We describe a case of TAVR which deploying the valve resulted in left ventricle outlet tract (LVOT) obstruction which was perfectly managed pacing and medical therapy.","PeriodicalId":21031,"journal":{"name":"Research in Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43698486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Faeze Daniali, M. Zanganehfar, Mohammad Ansari, Abolfath Diz
Atrial fibrillation (AF) is common in hypertrophic cardiomyopathy and it represents the most frequent cause of coronary artery embolism.We describe a male patient with hypertrophic cardiomyopathy with persistent AF, for which he consumed rivaroxaban. The patient received implantable cardioverter-defibrillator shocks for ventricular tachycardia, but he developed acute embolic occlusion in the left main coronary artery (LMCA) following the conversion of the AF rhythm into the sinus rhythm.
{"title":"Acute myocardial infarction secondary to left main coronary embolization after the conversion of an unwanted atrial fibrillation to the sinus rhythm","authors":"Faeze Daniali, M. Zanganehfar, Mohammad Ansari, Abolfath Diz","doi":"10.4103/rcm.rcm_57_21","DOIUrl":"https://doi.org/10.4103/rcm.rcm_57_21","url":null,"abstract":"Atrial fibrillation (AF) is common in hypertrophic cardiomyopathy and it represents the most frequent cause of coronary artery embolism.We describe a male patient with hypertrophic cardiomyopathy with persistent AF, for which he consumed rivaroxaban. The patient received implantable cardioverter-defibrillator shocks for ventricular tachycardia, but he developed acute embolic occlusion in the left main coronary artery (LMCA) following the conversion of the AF rhythm into the sinus rhythm.","PeriodicalId":21031,"journal":{"name":"Research in Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48808917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Naeini, Ermia Tabandeh, S. Taghavi, A. Amin, M. Mirtajaddini, Razieh Omidvar, M. Maleki, H. Bakhshandeh, N. Naderi
Introduction: The prognostic significance of filling pressures and the relationship between left and right heart filling pressures have been well characterized in patients with heart failure. In the present study, we sought to evaluate the prevalence of discordance between left- and right-sided filling pressures and their relationship with clinical characteristics, laboratory data, and outcome measures (mortality and heart transplantation) in patients who were registered in right heart catheterization registry of Rajaie Heart Center (RHC-RHC registry). Methods: The hospital information system was queried for all adult patients with diagnosis of chronic heart failure who had undergone right heart catheterization between July 2009 and July 2019 in heart failure and transplantation department. The following variables were measured for each patient: mean right atrial pressure; systolic and end-diastolic right ventricular pressures; systolic, diastolic, and mean pulmonary artery pressure; pulmonary capillary wedge pressure (PCWP); mixed venous oxygen saturation; and cardiac output and cardiac index by Fick technique. The RAP/PCWP ratio was also calculated. The outcome of interest was all-cause mortality and heart transplantation after the index right heart catheterization. All of the patients were monitored for all-cause mortality or heart transplantation until July 2020. Results: Among 1941 patients, a total of 1078 patients (75% male) were selected. The mean (standard deviation) of age was 42.7 (15.7) years. Heart failure reduced ejection fraction (HFREF) was found in the majority of patients (85.1%), with nonischemic dilated cardiomyopathy and ischemic cardiomyopathy being the most frequent etiologies. The concordance between right and left filling pressures is more noticeable in patients with HFREF and heart failure mildly reduced EF than in patients with heart failure preserved EF (HFPEF). The median (interquartile range) of follow-up duration was 24 (6–48) months. During the follow-up time, 676 (62.7%) patients met the study outcomes of interest within <5 days to 96 months following the index RHC. Conclusion: The results of this study show that right and left filling pressure may be discordant in up to one-third of patients with advanced heart failure. However, the right and left heart-filling pressures would be more concordance as the disease is more advanced.
{"title":"The prognostic significance of the discordance between right- and left-side filling pressures in advanced heart failure: Data from the right heart catheterization registry of rajaie heart center (RHC-RHC Registry)","authors":"S. Naeini, Ermia Tabandeh, S. Taghavi, A. Amin, M. Mirtajaddini, Razieh Omidvar, M. Maleki, H. Bakhshandeh, N. Naderi","doi":"10.4103/rcm.rcm_56_21","DOIUrl":"https://doi.org/10.4103/rcm.rcm_56_21","url":null,"abstract":"Introduction: The prognostic significance of filling pressures and the relationship between left and right heart filling pressures have been well characterized in patients with heart failure. In the present study, we sought to evaluate the prevalence of discordance between left- and right-sided filling pressures and their relationship with clinical characteristics, laboratory data, and outcome measures (mortality and heart transplantation) in patients who were registered in right heart catheterization registry of Rajaie Heart Center (RHC-RHC registry). Methods: The hospital information system was queried for all adult patients with diagnosis of chronic heart failure who had undergone right heart catheterization between July 2009 and July 2019 in heart failure and transplantation department. The following variables were measured for each patient: mean right atrial pressure; systolic and end-diastolic right ventricular pressures; systolic, diastolic, and mean pulmonary artery pressure; pulmonary capillary wedge pressure (PCWP); mixed venous oxygen saturation; and cardiac output and cardiac index by Fick technique. The RAP/PCWP ratio was also calculated. The outcome of interest was all-cause mortality and heart transplantation after the index right heart catheterization. All of the patients were monitored for all-cause mortality or heart transplantation until July 2020. Results: Among 1941 patients, a total of 1078 patients (75% male) were selected. The mean (standard deviation) of age was 42.7 (15.7) years. Heart failure reduced ejection fraction (HFREF) was found in the majority of patients (85.1%), with nonischemic dilated cardiomyopathy and ischemic cardiomyopathy being the most frequent etiologies. The concordance between right and left filling pressures is more noticeable in patients with HFREF and heart failure mildly reduced EF than in patients with heart failure preserved EF (HFPEF). The median (interquartile range) of follow-up duration was 24 (6–48) months. During the follow-up time, 676 (62.7%) patients met the study outcomes of interest within <5 days to 96 months following the index RHC. Conclusion: The results of this study show that right and left filling pressure may be discordant in up to one-third of patients with advanced heart failure. However, the right and left heart-filling pressures would be more concordance as the disease is more advanced.","PeriodicalId":21031,"journal":{"name":"Research in Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46067376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-01DOI: 10.1016/j.ihj.2021.11.168
P. Reddy, Praveen Nagula, Naga Venkata Raghava Balla, S. Hussain
{"title":"Pyopericardium manifesting as cardiac tamponade: A rare presentation of a common disease","authors":"P. Reddy, Praveen Nagula, Naga Venkata Raghava Balla, S. Hussain","doi":"10.1016/j.ihj.2021.11.168","DOIUrl":"https://doi.org/10.1016/j.ihj.2021.11.168","url":null,"abstract":"","PeriodicalId":21031,"journal":{"name":"Research in Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46478931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Farzad Kamali, M. Khorgami, Bayan Faridi, A. Soleimani
Radiofrequency ablation of concealed posteroseptal accessory pathway (AP) and differentiating the right posteroseptal from the left is a challenge for electrophysiologists. Considering different electrophysiological characteristics of posteroseptal AP can help to predict the successful ablation site. We report on a 45-year-old man with simultaneous orthodromic reentrant tachycardia and atrioventricular nodal reentrant tachycardia, both of which were successfully ablated in the right posteroseptal area at the site of the slow pathway. The arrhythmia with both right bundle branch block (RBBB) and left bundle branch block (LBBB) aberrant conduction was observed during our study. The ventriculoatrial (VA) interval increased approximately 25 ms when arrhythmia was conducted with LBBB aberrancy, while it did not change during the RBBB aberrancy. This finding is diagnostic for orthodromic reciprocating tachycardia using a left-sided AP rather than right. However, other parameters, such as delta VA interval and sharp/blunt feature in the proximal coronary sinus electrogram, indicated that the AP is located on the right posteroseptal area.
{"title":"A posteroseptal accessory pathway with conflicting predictors to determine the exact location of successful ablation","authors":"Farzad Kamali, M. Khorgami, Bayan Faridi, A. Soleimani","doi":"10.4103/rcm.rcm_44_21","DOIUrl":"https://doi.org/10.4103/rcm.rcm_44_21","url":null,"abstract":"Radiofrequency ablation of concealed posteroseptal accessory pathway (AP) and differentiating the right posteroseptal from the left is a challenge for electrophysiologists. Considering different electrophysiological characteristics of posteroseptal AP can help to predict the successful ablation site. We report on a 45-year-old man with simultaneous orthodromic reentrant tachycardia and atrioventricular nodal reentrant tachycardia, both of which were successfully ablated in the right posteroseptal area at the site of the slow pathway. The arrhythmia with both right bundle branch block (RBBB) and left bundle branch block (LBBB) aberrant conduction was observed during our study. The ventriculoatrial (VA) interval increased approximately 25 ms when arrhythmia was conducted with LBBB aberrancy, while it did not change during the RBBB aberrancy. This finding is diagnostic for orthodromic reciprocating tachycardia using a left-sided AP rather than right. However, other parameters, such as delta VA interval and sharp/blunt feature in the proximal coronary sinus electrogram, indicated that the AP is located on the right posteroseptal area.","PeriodicalId":21031,"journal":{"name":"Research in Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49364320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Iran is one of the countries hit hard and early by the corona virus disease 2019 (COVID-19) outbreak. Interventions for congenital and structural heart disease came to a halt in the initial part the year 2020, however as the pandemic seemed no closer to an end there was a mandate for elective catheterization procedures to be slowly and cautiously resumed. Aims and Objectives: In the present report we discuss the challenges we faced and the experiences earned as a cardiovascular tertiary center in the field of adult congenital and structural interventions in the COVID era. Material and Methods: Adult congenital and structural interventions were resumed in May 2020 with implementing strict screening protocols regulated by our institutional COVID committee. Patients were closely monitored for developing COVID-19 symptoms in hospital and two weeks following discharge. Results: In the regular review performed by the COVID committee there was no increase in new cases of the disease related to the interventional procedures and related admission. Conclusion: As the fate of pandemic remains unforeseeable, structural and congenital interventions need to be resumed in a sustainable fashion and with an instituted system of patient protection. The workflow might slow down during disease peaks with a catch-up in more stable disease periods.
{"title":"Adult congenital and structural interventions in coronavirus disease 2019 era: Report from an Iranian tertiary cardiovascular center","authors":"S. Saedi, A. Firouzi, Abdolvahab Baradaran","doi":"10.4103/rcm.rcm_46_21","DOIUrl":"https://doi.org/10.4103/rcm.rcm_46_21","url":null,"abstract":"Background: Iran is one of the countries hit hard and early by the corona virus disease 2019 (COVID-19) outbreak. Interventions for congenital and structural heart disease came to a halt in the initial part the year 2020, however as the pandemic seemed no closer to an end there was a mandate for elective catheterization procedures to be slowly and cautiously resumed. Aims and Objectives: In the present report we discuss the challenges we faced and the experiences earned as a cardiovascular tertiary center in the field of adult congenital and structural interventions in the COVID era. Material and Methods: Adult congenital and structural interventions were resumed in May 2020 with implementing strict screening protocols regulated by our institutional COVID committee. Patients were closely monitored for developing COVID-19 symptoms in hospital and two weeks following discharge. Results: In the regular review performed by the COVID committee there was no increase in new cases of the disease related to the interventional procedures and related admission. Conclusion: As the fate of pandemic remains unforeseeable, structural and congenital interventions need to be resumed in a sustainable fashion and with an instituted system of patient protection. The workflow might slow down during disease peaks with a catch-up in more stable disease periods.","PeriodicalId":21031,"journal":{"name":"Research in Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43524302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shakerian Farshad, P. Hamidreza, S. Salari, H. Mehdi, Kazemi Hssan
A 64-year-old woman admitted to our hospital (a tertiary care center) with symptoms of chest pain and dyspnea of functional class 2. Coronary angiography showed no stenosis, but injection of right coronary artery (RCA) showed suspicious shadow around the vessel. Computed tomographic angiography was done for further evaluation of probable iatrogenic aortic dissection, and incidental tumor was found encasing RCA proximal anterior to its origin of aorta. Magnetic resonance imaging suggested lymphangioma as the most probable cause (based on the tissue characterization criteria). According to benign nature of the tumor, follow-up by imaging was recommended.
{"title":"Incidental tumor blush of a mass encasing right coronary artery","authors":"Shakerian Farshad, P. Hamidreza, S. Salari, H. Mehdi, Kazemi Hssan","doi":"10.4103/rcm.rcm_55_21","DOIUrl":"https://doi.org/10.4103/rcm.rcm_55_21","url":null,"abstract":"A 64-year-old woman admitted to our hospital (a tertiary care center) with symptoms of chest pain and dyspnea of functional class 2. Coronary angiography showed no stenosis, but injection of right coronary artery (RCA) showed suspicious shadow around the vessel. Computed tomographic angiography was done for further evaluation of probable iatrogenic aortic dissection, and incidental tumor was found encasing RCA proximal anterior to its origin of aorta. Magnetic resonance imaging suggested lymphangioma as the most probable cause (based on the tissue characterization criteria). According to benign nature of the tumor, follow-up by imaging was recommended.","PeriodicalId":21031,"journal":{"name":"Research in Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46790567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Marziyeh HosseiniNezhad, M. Langarizadeh, S. Hosseini
Background: Mitral valve replacement procedure has increased in the Iran over the last years. For optimization of the results, as the other procedure, it needs statistical evaluation of the results, and then a system for the prediction of outcome. Hence, in this study, we generate a machine learning (ML)-based model to predict in-hospital mortality after isolated mitral valve replacement (IMVR). Materials and Methods: The patients who underwent IMVR from February 2005 to August 2016 were identified in a single tertiary heart hospital. Data were retrospectively gathered including baseline characteristics, echocardiographic and surgical features, and patient's outcome. Prediction models for in-hospital mortality were obtained using five supervised ML classifiers including: logistic regression (LR), linear discriminant analysis (LDA), support-vector machine (SVM), K-nearest neighbors (KNN), and multilayer perceptron (MLP). Results: A total of 1200 IMVRs were analyzed in our study. The study population was randomly divided into a training set (n = 840) and a testing set (n = 360). The overall in-hospital mortality was 4.2%. LR model had the best discrimination for 22 variables in predicting mortality after IMVR, with area under the receiver-operating curve (AUC), specificity, and sensitivity of 0.68, 0.73, and 0.58, respectively. A LDA model had an (AUC) of 0.73, compared to 0.56 for SVM, 0.51 for KNN, and 0.5 for MLP. Conclusions: We developed a robust ML-derived model to predict in-hospital mortality in patients undergoing IMVR. This model is promising for decision-making and deserves further clinical validation.
{"title":"Mortality prediction of mitral valve replacement surgery by machine learning","authors":"Marziyeh HosseiniNezhad, M. Langarizadeh, S. Hosseini","doi":"10.4103/rcm.rcm_50_21","DOIUrl":"https://doi.org/10.4103/rcm.rcm_50_21","url":null,"abstract":"Background: Mitral valve replacement procedure has increased in the Iran over the last years. For optimization of the results, as the other procedure, it needs statistical evaluation of the results, and then a system for the prediction of outcome. Hence, in this study, we generate a machine learning (ML)-based model to predict in-hospital mortality after isolated mitral valve replacement (IMVR). Materials and Methods: The patients who underwent IMVR from February 2005 to August 2016 were identified in a single tertiary heart hospital. Data were retrospectively gathered including baseline characteristics, echocardiographic and surgical features, and patient's outcome. Prediction models for in-hospital mortality were obtained using five supervised ML classifiers including: logistic regression (LR), linear discriminant analysis (LDA), support-vector machine (SVM), K-nearest neighbors (KNN), and multilayer perceptron (MLP). Results: A total of 1200 IMVRs were analyzed in our study. The study population was randomly divided into a training set (n = 840) and a testing set (n = 360). The overall in-hospital mortality was 4.2%. LR model had the best discrimination for 22 variables in predicting mortality after IMVR, with area under the receiver-operating curve (AUC), specificity, and sensitivity of 0.68, 0.73, and 0.58, respectively. A LDA model had an (AUC) of 0.73, compared to 0.56 for SVM, 0.51 for KNN, and 0.5 for MLP. Conclusions: We developed a robust ML-derived model to predict in-hospital mortality in patients undergoing IMVR. This model is promising for decision-making and deserves further clinical validation.","PeriodicalId":21031,"journal":{"name":"Research in Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42783340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Debasish Das, Abhinav Kumar, Jogendra Singh, Subhash R. Pramanik
We describe an interesting fluoroscopic calcification of the aortic knuckle assuming a reverse “C” shape in an atherosclerotic aorta in a 42-year-old male presenting with anterior wall ST-elevation myocardial infarction with dyslipidemia. Although calcification of the aortic knuckle and dilatation of the aorta is a common phenomenon in the elderly population, otherwise known as the “unfolding of aorta,” we observed this interesting pattern of calcification in a middle-aged person in an atherosclerotic aorta with calcification. The patient had double-vessel coronary artery disease with chronic total occlusion in the left anterior descending coronary artery and significant stenosis in the mid-segment of the right coronary artery, which we revascularized with drug-eluting stents and achieved TIMI III flow. Although calcium sign or C sign is described in aortic dissection and it is not specific to it, we observed this interesting pattern of calcification in a middle-aged person in the atherosclerotic aorta with dyslipidemia.
{"title":"Fluoroscopic “calcium sign” or reverse “c” sign of the aortic knuckle in a case of chronic total occlusion of left anterior descending coronary artery","authors":"Debasish Das, Abhinav Kumar, Jogendra Singh, Subhash R. Pramanik","doi":"10.4103/rcm.rcm_52_21","DOIUrl":"https://doi.org/10.4103/rcm.rcm_52_21","url":null,"abstract":"We describe an interesting fluoroscopic calcification of the aortic knuckle assuming a reverse “C” shape in an atherosclerotic aorta in a 42-year-old male presenting with anterior wall ST-elevation myocardial infarction with dyslipidemia. Although calcification of the aortic knuckle and dilatation of the aorta is a common phenomenon in the elderly population, otherwise known as the “unfolding of aorta,” we observed this interesting pattern of calcification in a middle-aged person in an atherosclerotic aorta with calcification. The patient had double-vessel coronary artery disease with chronic total occlusion in the left anterior descending coronary artery and significant stenosis in the mid-segment of the right coronary artery, which we revascularized with drug-eluting stents and achieved TIMI III flow. Although calcium sign or C sign is described in aortic dissection and it is not specific to it, we observed this interesting pattern of calcification in a middle-aged person in the atherosclerotic aorta with dyslipidemia.","PeriodicalId":21031,"journal":{"name":"Research in Cardiovascular Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48090124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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