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Elevated preprocedural CRP is not associated with increased risk for CI-AKI in patients undergoing PCI
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Case History :

A 35 year old male patient came to the clinic with the presenting complaint of breathlessness on exertion. He was apparently asymptomatic till two months back when he started developing the symptoms of fatigue and dyspnoea on exertion. He is a non-smoker, non-alcoholic, unmarried, has no previous history of any major illness, no family history of hypertension or diabetes. The dyspnoea on exertion was troubling him severely in the past 4 days. So he met his physician, who, after checking him referred him to clinic.

On Examination

Pulse-82/min
BP-130/86 mm/hg
Blood and Urine exam revealed no abnormal values.
ECG normal.

The patient was sent for angiography in order to find out the cause of his symptoms. We suspect him to be having anomolous origin of left circumflex artery.

Diagnosis

Anomolous origin of the left circumflex artery from right coronary artery.

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Investigation Reports :

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Discussion :

In adults congenital coronary anomalies are observed with a frequency of about 0.8%. The left circumflex coronary artery originating from the right sinus takes up more than half of all the anomalies seen. The prognosis of an anomalous origin of coronary arteries is decided by their proximal anatomical courses. Many cases of angina pectoris, myocardial infarction and sudden death are reported when the anomalous coronary artery passes between the aorta and pulmonary trunk.

The treatment options are surgery and PTCA

PTCA in patients with an anomalous circumflex is technically challenging. It demands a high degree of awareness, and complete evaluation of the coronary artery anatomy and distribution in order to avoid complications. The complication rate of coronary arteriography and PTCA is related to the duration of the procedure. Topaz et al.11 have described various aspects of orifice configuration, anatomy of the artery, location of atherosclerotic lesions and also guiding catheter selection. Proper guiding catheter selection decreases procedure time in PTCA involving anomalous coronary arteries and thus increases success rate.

Reference:  Indian Heart J 2001; 53: 79-82

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