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Biomedical subjects

R A Chahine

Publications and source records attributed to R A Chahine.

At least 19 recordsLinked to original sources
PubMed1992

Anomalous coronary arteries: angiographic findings in 80 patients.

Among 13010 adults who underwent coronary arteriography, 80 (0.61%) patients had a total of 83 anomalous coronary arteries. Thirty-three (41%) of the patients were of Hispanic origin, while out of the entire population studied 30% were Hispanic. The right coronary artery was the most common anomalous vessel. It was identified in 50 (62%) patients, arising in 35 from the left aortic sinus, in 14 from the posterior sinus, and in 1 from the left coronary artery. An anomalous circumflex artery was recognized in 22 (27%) patients. Nine (11%) patients presented an anomalous left anterior descending artery, 1 patient an anomalous left main coronary artery, and another an anomalous septal perforator artery. Twenty-three (29%) patients had concomitant congenital heart abnormalities, most commonly. bicuspid aortic valve and mitral valve prolapse. In each of 5 patients with complex congenital heart disease the course of the anomalous vessel could have interfered with a surgical procedure. In 4 cases anomalous coronary arteries were associated with either anomalous systemic venous circulation or anomalous cardiac veins. In 5 (6%) patients only, the anomalous coronary artery was solely responsible for a clinical event. Coronary atherosclerosis of the anomalous arteries was found in 28% of the patients, while the overall incidence of the disease in this series was 65%. Thus, anomalous coronary arteries are associated with a high incidence of congenital heart diseases, but do not appear to be associated with an increased risk for development of coronary atherosclerosis. The angiographic recognition of these vessels is important in patients who undergo coronary angioplasty or cardiac surgery. Variations in the frequency of congenital coronary anomalies as reported herein may be attributed to a genetic background.

Abnormalities, Multiple↗
PubMed1989

Acute ventricular septal rupture. Angiographic-morphologic features and clinical assessment.

Twenty patients with acute ventricular septal rupture underwent cardiac catheterization. Prior to catheterization, 17 patients were in Killip class 3-4. Mean cardiac index and cardiac output were 2.03 +/- 0.81 L/min/m2 and 3.55 +/- 1.33 L/min, respectively. Based on a recent pathologic description of septal rupture, we encountered by angiography and during surgery, two morphologic types of rupture: simple type which appears as a direct through-and-through communication between the ventricles, and complex type which presents hemorrhagic tracts in the septum with the opening into the ventricles at different levels. Considering the management of patients with septal rupture and the clinical outcome in our series, it is suggested that there is a need to minimize invasive angiographic procedures prior to early surgical correction of the ruptured septum.

Acute Disease↗
PubMed1986

Cardiac arrhythmias associated with prophylactic pacing during coronary angiography.

Data from 518 consecutive cardiac catheterizations were analyzed to test the value of prophylactic pacemaker insertion during coronary angiography and to compare the incidence of arrhythmic complications in patients with and without pacemakers. In patients without pacing (n = 273), 1 episode of ventricular fibrillation occurred, which responded promptly to defibrillation. Sinus bradycardia (fewer than 30 beats/min for 10 seconds) was recorded in 74 patients (27%) and required treatment in 30 (11%). No patient required or would have benefited from pacemaker placement. Of the 245 patients with prophylactic pacemakers, there was an increased incidence of all ventricular (9 vs 1; p less than 0.013) and supraventricular (5 vs 0; p less than 0.046) arrhythmias. Pacemaker-associated induction of ventricular fibrillation occurred in 2 patients and was clearly related to electrical stimulation during a normally non-vulnerable period of the cardiac cycle. In conclusion, routine prophylactic pacemaker insertion during coronary angiography is not warranted in patients with normal sinus rhythm and normal atrioventricular conduction. More information is needed to determine if pacing is needed in patients with conduction system disease.

Angiography↗
PubMed1986

Coronary artery spasm. What is its role in ischemic heart disease?

Knowledge of the pathophysiology of myocardial ischemia has been greatly enhanced recently by new information on coronary artery spasm. This phenomenon accounts for the mechanism underlying the attacks of resting chest pain in Prinzmetal's angina and plays a role in almost all aspects of ischemic heart disease. The diagnosis of coronary artery spasm can be made presumptively with noninvasive methods, but definitive documentation is usually obtained in the cardiac catheterization laboratory. The nitrate derivatives and the calcium antagonists provide a safe and effective approach to therapy.

Adrenergic beta-Antagonists↗
PubMed1985

The diagnosis of coronary artery spasm in the cardiac catheterization laboratory.

Coronary artery spasm can now be well documented in the cardiac catheterization laboratory. At present, reliable criteria are available for the diagnosis of severe episodes that are characteristic of patients with Prinzmetal's variant angina. Newer criteria for the diagnosis of milder episodes of spasm are gradually being developed. Optimal criteria may become available with further progress of quantitative angiography. Provocation techniques for the induction of an attack of spasm in the cardiac catheterization laboratory are widely available. Of these, ergonovine testing is the most popular. The tests can usually be performed by experienced angiographers with impressive safety and provide a high degree of sensitivity and specificity when used in patients with the clinical diagnosis of variant angina. Although the research applications of such techniques are extremely broad, their practical clinical indications are somewhat limited to the work-up of patients with infrequent chest pains and normal or near-normal coronary arteriograms. There are other indirect methods for the diagnosis of coronary spasm, but the ideal technique is not available yet. Further expansion of newer modalities for the diagnosis of coronary artery spasm will certainly enhance our understanding of myocardial ischemia and will improve our ability to manage patients with ischemic heart disease.

Angina Pectoris, Variant↗
PubMed1984

Anomalous separate origin of the septal perforator coronary artery from the left sinus of valsalva.

The anomalous separate origin of the first septal perforator from the left sinus of Valsalva is described. Previously documented anomalous origins of the septal perforator include the left main coronary artery, the right coronary artery, the right sinus of Valsalva, a diagonal coronary artery, the circumflex coronary artery, and its obtuse marginal branch. We could not find any previous description of the septal perforator originating from a separate ostium in the left sinus of Valsalva.

Adult↗
PubMed1984

Isolated left posterior fascicular block associated with acquired ventricular septal defect.

Isolated left posterior fascicular block in the absence of associated right bundle-branch block is a rare electrocardiographic finding. In view of its anatomy and the fact that it receives a dual blood supply, the posterior fascicle of the left bundle branch appears to be less vulnerable than the anterior fascicle or the right bundle. Mechanical disruption of the posterior fascicle can produce isolated left posterior fascicular block. This has been demonstrated in animal models. However, such occurrence has not been noted in humans. We present two cases of inferior wall myocardial infarction, complicated by rupture of the inferior septum, resulting in isolated left posterior fascicular block. The development of isolated left posterior fascicular block complicating myocardial infarction may, therefore, serve to alert to the possible underlying septal rupture.

Bundle-Branch Block↗