Pants for Women On Sale in Outlet White Cotton 2017 28 Stella Jean Discount High Quality Free Shipping Looking For Online Cheap UngUidwb

SKU6947666843871919
Pants for Women On Sale in Outlet, White, Cotton, 2017, 28 Stella Jean
Pants for Women On Sale in Outlet, White, Cotton, 2017, 28 Stella Jean
raw hem cropped jeans Blue R13 Sale 2018 Outlet Wholesale Price YgubK4
Texas Admissions
The University of Texas at Austin
Menu
Advertisement
For UK healthcare professionals only
This website is intended for UK healthcare professionals only TALL Long Sleeve Grandad Top Bright white Selected For Sale Online Store CKrh0vW08
| Register

Tushar Raina Specialist Registrar in Cardiology

Ever D Grech Consultant Cardiologist

David Cumberland Consultant in Cardiac Intervention

South Yorkshire Cardiothoracic Centre, Northern General Hospital, Herries Road, Sheffield, S5 7AU

Correspondence to: Dr T Raina Tushardr@aol.com

Dextrocardia is a rare anomaly with an estimated prevalence of about one in 10,000. The incidence of coronary artery disease is the same as in the general population. We report two cases of successful percutaneous treatment of coronary stenoses and aim to highlight some of the additional technical challenges that such patients present to the Interventional Cardiologist.

Case report 1

A 51-year-old man with known dextrocardia presented with a 12-month history of angina and an early positive exercise electrocardiogram (ECG). His risk factors were hypertension, hyperlipidaemia and cigarette smoking. Physical examination revealed a right-sided apex beat and chest radiography confirmed the presence of dextrocardia.

A 12-lead ECG ( figure 1 ) showed sinus rhythm with a reduction in the R-wave voltage in the standard chest leads and a corresponding increase in the right-sided leads.

Coronary angiography of the left coronary system (right sided) revealed minor non-flow limiting disease. The morphologic right coronary artery (left sided) however, revealed a severe discrete stenosis ( figure 2A ) in the mid-vessel. Following a review of the coronary anatomy, percutaneous intervention was planned for a subsequent sitting.

The procedure was performed using a 6 French AL-2 guide catheter and a high-torque, extra support guidewire. The lesion was directly stented with a 3.5 x 18 mm Zeta stent (Guidant). An excellent angiographic result was obtained ( figure 2B ) and there were no complications.

Case report 2

An 84-year-old woman with known dextrocardia was transferred from one of our referring hospitals with early post infarct unstable angina following an anterior ST elevation myocardial infarction for which she had received thrombolytic therapy.

Her risk factors were hypertension, hyperlipidaemia and previous smoking habit. Physical examination revealed findings consistent with situs inversus. A 12-lead ECG with leads reversed appropriately for dextrocardia, revealed well-controlled atrial fibrillation with widespread T wave inversion in the anterior chest leads. Chest radiography showed dextrocardia with a right-sided aortic knuckle as well as a right-sided gastric air bubble. Echocardiography confirmed a normal cardiac structure with impairment of left ventricular systolic function and evidence of hypokinesia in the antero-septal left ventricular territory.

Coronary angiography of the morphologic left coronary system (right sided) revealed a subtotally occluded proximal left anterior descending artery ( figure 3A ) and a left circumflex artery that was free of disease. The anatomical right coronary artery (left sided) revealed a moderate stenosis in a small-calibre distal posterior descending artery.

A decision was made to proceed to percutaneous revascularisation of the left anterior descending artery at the same sitting. The procedure was performed using a 6 French JL 3.5 guide catheter and Galeo medium guidewire. The subtotally occluded proximal left anterior descending artery was sequentially pre-dilated using 1.5 and 2.0 mm balloon catheters prior to deployment of a 2.5 x 20 mm paclitaxel-coated Taxus stent (Boston Scientific). This resulted in an excellent angiographic appearance ( figure 3B ) and there were no complications.

Discussion

The first cardiac catheterisation in dextrocardia was reported in 1973, the first coronary artery bypass surgery in 1980 and the first percutaneous intervention in dextrocardia was performed in 1987. There have since been a few reports of percutaneous treatment of coronary stenoses in dextrocardia patients.

Performing percutaneous coronary intervention in patients with dextrocardia presents several challenges to the interventional cardiologist. These include selection of appropriate diagnostic and interventional catheters, acquisition of modified interventional views and in some cases mirror image visualisation using image reversal software.

Conflict of interest

None declared.

References

Leave a Reply

You must be Very Cheap Online Mabel Dress in Metallic Silver size S also in XS Lovers Friends Browse For Sale Discount Top Quality Great Deals For Sale VZ2NZl67j
to post a comment.

Not yet a member? high waist denim culottes Stella McCartney Clearance 2018 Newest Release Dates Cheap Online The Cheapest Exclusive Sale Online Best Wholesale Sale Online qLIULY36f5
for free.

back to top

November 2017 Br J Cardiol 2017;24:129

REDUCE shows non-inferiority of short versus long DAPT in acute coronary syndrome

October 2017

Black Tassel Shoulder Extreme Plunge Bodycon Dress Pretty Little Thing Cheapest Price Cheap Online Free Shipping Hot Sale ip2KxgBb4J

November 2016 Br J Cardiol 2016;23:155–8

Risk factors for femoral arterial complications and management

April 2016 Br J Cardiol 2016;23:78

Floral Splice Swimsuit Multi Jaded London Many Colors Sale Wiki Cheap Sale Amazing Price omiWloNw

BJC LEARNING

Potassium and the heart

BJC LEARNING

Heart failure

Cardiorenal Forum 2017

Hyperkalaemia debate

Supplement

Perspectives in chronicheart failure treatment

BJC LEARNING

Anticoagulation

Advertisement

For healthcare professionals only

Advertisement

For healthcare professionals only

Advertisement

@BrJCardiol

Shore Serena Ruffled Embroidered Crinkledcotton Dress White Talitha Authentic WIrBwKZ
very useful to learn about BNP and cardiac investigations

jaikrishnan | July 9, 2018 On article Heart failure module 2: diagnosis

Support Aeon

‘Your articles are smart, well written, and enriching. This is what intelligentsia is about.’

Dien H, USA, Friend of Aeon

Aeon is a registered charity committed to the spread of knowledge and a cosmopolitan worldview. But we can’t do it without you.

Support Aeon

Aeon is a registered charity committed to the spread of knowledge and a cosmopolitan worldview. Our mission is to create a sanctuary online for serious thinking.

No ads, no paywall, no clickbait – just thought-provoking ideas from the world’s leading thinkers, free to all. But we can’t do it without you.

Womens Strings Guess Buy Cheap Extremely 0Npo9vfBrX

Become a Friend of Aeon to save articles and enjoy other exclusive benefits

Support Aeon

Subscribe to our newsletter

Updates on everything new at Aeon.

Newsletter Privacy Policy

Aeon email newsletters are issued by the not-for-profit, registered charity Aeon Media Group Ltd (Australian Business Number 80 612 076 614). This Email Newsletter Privacy Statement pertains to the personally identifying information you voluntarily submit in the form of your email address to receive our email newsletters

More generally, when visiting the Aeon site you should refer to our site Privacy Policy .

This Email Newsletter Privacy Statement may change from time to time and was last revised 5 June, 2018.

By clicking ‘Subscribe’ you agree to the following:

Unsubscribing

You can change your mind at any time by clicking the ‘unsubscribe link’ in the footer of emails you receive from us, or by contacting us at Clearance Shop Offer Hot Reversible Bandeau Bikini Top in Purple size L also in MS Maaji Limited Recommend MUe4JnE

If you want to review and correct the personal information we have about you, you can click on ‘update preferences’ in the footer of emails you receive from us, or by contacting us at support@aeon.co

Security of your personal information

We are committed to ensuring that your information is secure. We have taken reasonable measures to protect information about you from loss, theft, misuse or unauthorised access, disclosure, alteration and destruction. No physical or electronic security system is impenetrable however and you should take your own precautions to protect the security of any personally identifiable information you transmit. We cannot guarantee that the personal information you supply will not be intercepted while transmitted to us or our marketing automation service Mailchimp.

Sharing your personal information

We will not disclose your personal information except: (1) as described by this Privacy Policy (2) after obtaining your permission to a specific use or disclosure or (3) if we are required to do so by a valid legal process or government request (such as a court order, a search warrant, a subpoena, a civil discovery request, or a statutory requirement). We will retain your information for as long as needed in light of the purposes for which is was obtained or to comply with our legal obligations and enforce our agreements.

Contact

800.215.2776

1146 19th Street, NW Suite 400 Washington, DC 20036

Contact Us

Service Providers
About Us
Resources