Left anterior descending

Figure 4.2 Epicardial ECG recorded from an isolated blood-perfused rat heart at the moment of reperfusion. The heart was made regionally ischaemic by occluding a snare around the left anterior descending coronary artery and, after 10 min, reperfused by releasing the snare. Note the rapid onset of ventricular tachycardia (VT) and its subsequent degeneration into ventricular fibrillation (VF). Reproduced with permission from Lawson (1993).

Proximal circumflex Proximal left anterior descending First obtuse marginal Second obtuse marginal Third obtuse marginal... 

Two-vessel coronary artery disease (60% right coronary artery [RCA] and 80% left anterior descending artery [LAD] occlusion) after intracoronary CYPHER stent placement to the mid-LAD artery lesion 10 months ago. 

LC is a 51 -year-old female with a history of CHD (stent placement in the left anterior descending coronary artery 3 years prior) and type 2 diabetes who is referred to you for follow-up of her cholesterol. She is taking simvastatin 20 mg once daily in the evening for her cholesterol, and metformin 2000 mg once daily in the evening and piogliti-zone 15 mg once daily for diabetes. Her diabetes is well controlled. Her laboratory test results are within normal limits, except for her fasting lipid profile total cholesterol 215 mg/dL (5.57 mmol/L), triglycerides 135 mg/dL (1.53 mmol/L), HDL cholesterol 51 mg/dL (1.32 mmol/L), and LDL cholesterol 137 mg/dL (3.55 mmol/L). 

LAD Left anterior descending left axis deviation N V Nausea and vomiting... 

In Fig. 2.2, the PET perfusion images show severe stenosis or occlusion of the left circumflex (LCx) and right (RCA) coronary arteries with a moderately severe stenosis of the left anterior descending (LAD) coronary artery proximal to its second diagonal branch. The ejection fraction (EF) and regional LV contraction were normal. Therefore, this example illustrates purely ischemic myocardium without scar and without injured or poorly contracting myocardium. 

Target lesion coronary artery Left anterior descending 223 Other 33S... 

Hueb WA Bellotti G, de Oliveira SA, et al. The Medicine, Angioplasty and Surgery Study a prospective, randomized trial of medical therapy, balloon angioplasty, or bypass surgery for single proximal left anterior descending artery stenosis. J Am Coll Cardiol 1995 26 606. 

Coronary artery bypass was found to decrease blood plasma TAC (T1). Similarly, a brief episode of myocardial ischemia due to elective coronary angioplasty on the left anterior descending coronary artery decreased TAC of blood plasma in the great cardiac vein after 1 and 5 min of the angioplasty TAC returned to normal after 15 min (B22). Another study found lower TAC in the great cardiac vein than in aorta aortic levels before baloon inflation, and its further decrease after 1 min (R19). 

Abbreviations-. DM, diabetes mellitus LAD, left anterior descending artery MLD, minimal lumen diameter. ... 

Abbreviations AMI, acute myocardial infarction LAD, left anterior descending LCX, left circumflex LMCA, left main coronary artery RCA, right coronary artery pt, patient. 

Abbreviations BMS. bare metal stent LAD. left anterior descending artery LCX, left circumflex coronary artery LM. left main MVD. multiple vessel disease RCA. right coronary artery. 

The most frequent locations of the target lesion were the mid-left anterior descending vessel (39 patients, 23%), proximal left descending vessel (37 patients, 21 %), and mid-right coronary artery (35 patients, 20%). Mean lesion length was I 1.5 5.0 mm (range from 4 to 25 mm). The most commonly recorded target lesion classification was type BI (86 patients, 50%). 

The first phase I clinical trial of coronary angiogenesis demonstrated the safety of intramyocardial injection of 0.01 mg/kg of FGF-I (79), A total of 40 patients undergoing CABG of the internal mammary artery (IMA) to left anterior descending coronary artery (LAD) were randomized to receive intramyocardial injections of either 0,01 mg FGF-1 or placebo. All the patients had further stenoses of the LAD distal to the anastomosis, Coronary angiography 12 weeks after treatment showed increased capillary refill in patients... 

Abbreviations BM-MNC. tone marrow mononuclear cell CF. cardiac fibroblast CM, cardiomyocyte FB. fibroblast LAD. left anterior descending artery LV, left ventricle SKMB, skeletal myoblast. 

Possible complications include massive myocardial infarction due to retrograde flow around the occlusion balloon, complete heart block, ventricular fibrillation, stroke, dissection of the left anterior descending artery, and right coronary artery thrombosis. Though high grade atrioventricular blockage occurs relatively frequently, procedural mortality rate is low (0-4%) and severe complications are rare and often avoidable (7-10). 

A profound complication of septal ablation is anterior Ml due to ethanol reflux from the septal perforator down the left anterior descending artery. This can be avoided by careful position of the balloon and angiographic monitoring. Other rare complications include coronary dissection, perforation, thrombosis, and spasm. 

I/R = ischemia/reperfusion CA = coronary artery LV = left ventricle MI = myocardial infarction and LAD = left anterior descending branch of left coronary artery. 

To measure left ventricular external diameter (LVED), two ultrasonic transducers are fixed to the left ventricular wall. One crystal is sutured to the posterior wall within the rectangular area formed by the left circumflex coronary artery and the left posterior descending artery. The other one is placed near the first diagonal branch of the left anterior descending coronary artery. Exact positioning is assured with an oscilloscope. 

A 34-year-old man developed palpitation, shortness of breath, and chest pain. He had smoked a quarter to a half an ounce of marijuana per week and had taken it 3 hours before the incident. He had ventricular tachycardia at a rate of 200/minute with a right bundle branch block pattern. Electrical cardioversion restored sinus rhythm. Angiography showed a significant reduction in left anterior descending coronary artery flow rate, which was normalized by intra-arterial verapamil 200 micrograms. 

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