Search

Myocardial noncompaction of the ventricular myocardium is a rare congenital cardiomyopathy characterized by excessively protrusive trabeculae and deep trabecular recesses in one or more segments of the ventricle. A 37-year-old male patient with prominent kyphoscoliosis presented with dyspnea. Transthoracic echocardiography showed trabeculations and deep intratrabecular recesses along the ventricular cavity in the apical and lateral segments of the left ventricle. Color Doppler imaging showed blood flow in these recesses. Diameters of the left ventricle and atrium were increased, with global hypokinesis of the left ventricle (ejection fraction 30%). Severe aortic valve stenosis was noted. Pulmonary function test showed moderate restriction. Due to high perioperative mortality, the patient was scheduled to medical treatment.

Left main coronary artery originating from the right coronary artery (RCA) is a rare anomaly. A 52-year-old male patient was submitted to catheterization laboratory for primary percutaneous coronary angioplasty with a diagnosis of acute anterior myocardial infarction. He had several risk factors including smoking, hypertension, and type 2 diabetes mellitus. Selective right coronary angiography showed an eccentric 85% stenosis at the mid-segment of the RCA, and the left main coronary artery originating from the right aortic sinus. The proximal segment of the left main coronary artery was completely occluded with thrombus and there was severe stenosis (95%) at the bifurcation of the left anterior descending artery with the circumflex artery. A metal stent was implanted in the stenotic segment of the left main coronary artery. The patient was discharged on the seventh day of stent implantation without any complications. Coronary artery bypass grafting was planned for stenotic lesions in the RCA and at the bifurcation of the left anterior descending artery with the circumflex artery.

Coronary stent implantation was firstly performed as only a bail-out procedure for poor angioplasty results, but nowadays it has become a primary modality of coronary revascularization. The deployment of intracoronary stents during percutaneous transluminal coronary angioplasty has been shown in a number of clinical trials to provide additional benefits regarding the rate of restenosis and clinical outcome over angioplasty alone. Direct stent implantation is the term applied to the technique of coronary stent implantation without firstly preparing the way with balloon predilation. In simple lesion subsets, both initial success rate and restenosis rate are superior to conventional balloon angioplasty. There is a considerable potential advantage of direct stenting over conventional stenting with respect to savings in procedural time, contrast load, and fluoroscopy time. Because predilation is not employed, there is an additional saving on angioplasty balloons, and a more efficient and less usage of stents is possible by minimizing the dissection rate. Lesion selection plays a major role in the high success rates. Long, heavily calcified lesions, small vessels or lesions with excessive proximal tortuosity are not considered suitable for direct stenting. With additional experience and continued improvement in stent technology it seems likely that more patients will be potential candidates for direct stenting.