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Paolo Angelini

Publications and source records attributed to Paolo Angelini.

At least 19 recordsLinked to original sources
PubMed2006

Symptomatic anomalous origination of the left coronary artery from the opposite sinus of valsalva. Clinical presentations, diagnosis, and surgical repair.

Anomalous origination of a coronary artery can have serious, even fatal, consequences. Intravascular ultrasonography has recently provided new insights into anomalous coronary artery origination from the opposite sinus of Valsalva. On the basis of these insights, we describe 3 typical forms of this anomaly with left coronary artery involvement, including clinical presentations, diagnostic methods (particularly intravascular ultrasonography), and details of surgical treatment. In this case series, the left coronary artery originated from the noncoronary sinus in 1 patient and from the right sinus in another patient. In the 3rd patient, both the left and right coronary arteries originated from the ascending aorta above the sinotubular junction. Baseline areas of stenosis ranged from 48.6% to 70.1%. Intravascular ultrasonography was the only method that enabled us to clarify the mechanisms and the severity of the anomaly. Pharmacologic challenge was useful to predict worsening that might have occurred under physiologic conditions. We found that, in cases of symptomatic left anomalous coronary artery origination from the opposite sinus of Valsalva, the proximal segment of the left coronary artery consistently has (1) an intramural course inside the aortic wall; (2) hypoplasia, as determined by its circumference; and (3) a cross-sectional ovaloid deformity (lateral compression) with phasic and exercise-induced worsening of the deformity With regard to surgical treatment, ostioplasty is preferable to coronary bypass. To establish sound guidelines for managing these anomalies, a larger series should be studied prospectively with quantitative parameters and long-term follow-up.

Aged↗
PubMed2006

Daughter, you broke my heart: accidental thrombosis at a muscular bridge.

We report the case of a 59-year-old trained runner, who sustained an acute myocardial infarction, with residual effort angina, following extreme exertion while experiencing severe anxiety. Coronary angiography revealed that this patient had a myocardial bridge at the mid-left anterior descending artery, and an occlusive clot had developed at the proximal end of the muscular bridge. We discuss the possible relationships between the various circumstances of this sudden event. We argue that, under exceptional conditions, myocardial bridges can lead to myocardial infarction by clot formation.

Angina Pectoris↗
PubMed2005

Unusual case of single coronary artery: questions of methods and basic concepts.

Coronary artery anomalies continue to constitute a confusing subject in modern cardiology. While most anomalies are considered to have a benign prognosis, the literature and cardiologic culture frequently imply an intrinsic, systematic association of coronary anomalies with severe clinical presentations. We present a case of unusual single coronary artery, in order to elucidate the logical process that should be used to study similar cases. A 56-year-old female presented with a 6-year history of atypical chest pain and an abnormal electrocardiogram. Heart catheterization revealed an abnormal coronary tree interpreted by some observers as a benign coronary anomaly, by others to indicate the need for coronary angioplasty. A nuclear stress test was performed after 1 year of unrelenting symptoms and showed mildly abnormal findings, leading to a more definitive angiographic study that clarified the anatomy and the prognosis. The case is essentially and only an example of single coronary artery with origin of all branches from the right coronary sinus, but with an unusual triple origin of the branches serving the left anterior descending territory. The notion that a case of single coronary artery may have significant prognostic and clinical repercussion is frequently repeated in the current inconclusive literature. A rational discussion should deal both with individual case objective evidence and theoretical general consideration.

Angina Pectoris, Variant↗
PubMed2005

Stem cell treatment of the heart: a review of its current status on the brink of clinical experimentation.

Stem cells are multipotent, undifferentiated cells capable of multiplication and differentiation. Preliminary experimental evidence suggests that stem cells derived from embryonic or adult tissues (especially bone marrow) may develop into myocardial cells. Some experts believe that this phenomenon occurs naturally in human beings, specifically during recovery from a myocardial infarction. Recently, stem cells have been used with the therapeutic intention of regenerating damaged tissues. Cardiac experiments, mainly with adult homologous stem cells, have proved that this therapy is safe and may improve myocardial vascularization and pump function. We review current fundamental concepts regarding the normal development of embryonic stem cells into myocardial tissue and the heart as a whole. We describe the multiple conditions that naturally enable a stem cell to become a myocardial cell and a group of stem cells to become a heart. We also discuss the challenge of translating basic cellular and molecular mechanisms into effective, clinically relevant treatment options.

Animals↗
PubMed2004

Nebulous imaging.

Explore the source record for details and available documents.

Coronary Angiography↗
PubMed2003

Metabolically controlled reperfusion in acute myocardial infarction: should the polarizing solution be given subselectively?

BACKGROUND: In working rat hearts, metabolic support of injured tissue enhances recovery after acute myocardial infarction. Clinical experience with a systemic "polarizing solution" supports this claim. OBJECTIVES: In a dog model of ischemia/reperfusion, we tested the feasibility of subselectively supplying adapted metabolic substrates before instituting blood reperfusion. METHODS: Thirty-five dogs underwent ligation of the proximal left anterior descending artery and collaterals for 90 minutes. The animals were randomly assigned to receive direct blood reperfusion (Group I), intracoronary glucose, insulin, and potassium (Group II), or intracoronary glucose, insulin, and potassium plus propionyl-L-carnitine (PLC) (Group III). After 30 minutes of artificial reperfusion, prograde blood flow was resumed in groups II and III. A routine necropsy was performed 3 to 5 days later. Primary endpoints were severe arrhythmias, death, markers of infarct size, and specific histologic features. RESULTS: We excluded 4 dogs for technical reasons and 2 others for preexisting cardiomyopathy. In the remaining 29 animals, large apical infarctions were documented ventriculographically during arterial ligation. One dog died of irreversible ventricular fibrillation during the initial ischemic period, and 9/28 dogs (32.1%) died during early reperfusion. Ventricular fibrillation was more common with 10% (versus 5%) dextrose concentrations and was eliminated by PLC. Irreversibly injured (versus jeopardized) areas of myocardium were more common in Group III (85.9 19.3%) than in Groups I and II (16.9 10.8%). CONCLUSION: Subselective infusion of metabolically supportive solutions during acute myocardial infarction is technically feasible. To prevent osmotic endothelial damage, the perfusate must have a low (< 5%) dextrose content.

Animals↗
PubMed2003

Anomalous coronary artery arising from the opposite sinus: descriptive features and pathophysiologic mechanisms, as documented by intravascular ultrasonography.

BACKGROUND: Anomalous coronary artery originating from the opposite sinus of Valsalva (ACAOS) can cause syncope, myocardial infarction, and sudden death in the absence of critical, fixed stenosis. In the following cases, intravascular ultrasonography (IVUS) was used to document the functional anatomy in ACAOS. This application has not been previously reported in the literature. METHODS AND RESULTS: In four patients with symptomatic ACAOS and IVUS, the anomalous vessels had a tangential proximal course, and a proximal intramural tract of variable length had fixed lateral compression that worsened during systole. By pressure wire, no significant gradient was present at baseline or after adenosine administration. Ergonovine provocation elicited no spasticity of proximal ectopic segments. Dobutamine, atropine, and rapid saline infusion provoked no symptoms or angiographic changes but did provoke subtle IVUS changes. To correlate these changes with the prognosis, further longitudinal evaluation, involving larger series, will be required. CONCLUSION: IVUS and pressure-wire methods may be valuable for subclassifying ACAOS and other coronary anomalies in terms of their pathophysiologic repercussions and for substantiating individual indications for treatment. To establish definitive recommendations and protocols, a larger study will be required.

Adolescent↗