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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 61-year-old man&#44; with a history of coronary heart disease and percutaneous coronary intervention&#44; with stents in the right coronary and circumflex arteries&#44; was referred to our center for left atrial appendage &#40;LAA&#41; closure&#46; He had atrial fibrillation with high thromboembolic risk &#40;CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>VASc&#61;4&#41; and oral anticoagulation was formally contraindicated because of recurrent severe bleeding&#46; Selective angiography of the LAA &#40;Video 1&#41; showed a close relationship between the LAA &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#44; asterisk&#41; and the circumflex artery &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#44; arrow&#41;&#44; well defined by the previously implanted stents&#46; A computed tomography scan performed after a previous episode of diffuse alveolar hemorrhage showed similar findings &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#44; arrow&#41;&#46; A 22-mm Amplatzer Amulet device was successfully placed&#44; with no residual leak&#46; Intraoperative monitoring by transesophageal echocardiography and post-procedural radioscopy confirmed the close relationship between the device and the circumflex artery &#40;<a class="elsevierStyleCrossRefs" href="#fig0015">Figures 3 and 4</a>&#44; Videos 2 and 3&#41;&#44; which is vital to keep in mind in order to prevent complications during the procedure&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">LAA closure is a safe and effective intervention used to prevent stroke and systemic embolism in patients with atrial fibrillation and contraindications for oral anticoagulation&#46; Nevertheless&#44; there may be procedure-related complications such as device embolization and left atrial wall perforation&#46; The close relationship between the LAA and circumflex artery place this latter structure and its branches &#40;including the sinus node artery in 30&#37; of patients&#41; at risk during the procedure&#46; This condition must be considered if the patient develops atrial arrhythmias or signs of myocardial ischemia during the procedure&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical disclosures</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of human and animal subjects</span><p id="par0015" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Confidentiality of data</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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Image in Cardiology
Close relationship between circumflex artery and left atrial appendage
Artéria circunflexa e apêndice arterial esquerdo: relação perigosa
Juan Caro-Codón
Autor para correspondência
juancarocd@gmail.com

Corresponding author.
, Guillermo Galeote, Teresa López-Fernández, Ángel Sánchez-Recalde, Santiago Jiménez-Valero, Raúl Moreno
Serviço de Cardiologia, Hospital Universitario La Paz, Madrid, Spain
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Thoracic computed tomography performed after an episode of alveolar hemorrhage also reveal the proximity of the circumflex artery to the left atrium and left atrial appendage &#40;arrow&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 61-year-old man&#44; with a history of coronary heart disease and percutaneous coronary intervention&#44; with stents in the right coronary and circumflex arteries&#44; was referred to our center for left atrial appendage &#40;LAA&#41; closure&#46; He had atrial fibrillation with high thromboembolic risk &#40;CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>VASc&#61;4&#41; and oral anticoagulation was formally contraindicated because of recurrent severe bleeding&#46; Selective angiography of the LAA &#40;Video 1&#41; showed a close relationship between the LAA &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#44; asterisk&#41; and the circumflex artery &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#44; arrow&#41;&#44; well defined by the previously implanted stents&#46; A computed tomography scan performed after a previous episode of diffuse alveolar hemorrhage showed similar findings &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#44; arrow&#41;&#46; A 22-mm Amplatzer Amulet device was successfully placed&#44; with no residual leak&#46; Intraoperative monitoring by transesophageal echocardiography and post-procedural radioscopy confirmed the close relationship between the device and the circumflex artery &#40;<a class="elsevierStyleCrossRefs" href="#fig0015">Figures 3 and 4</a>&#44; Videos 2 and 3&#41;&#44; which is vital to keep in mind in order to prevent complications during the procedure&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">LAA closure is a safe and effective intervention used to prevent stroke and systemic embolism in patients with atrial fibrillation and contraindications for oral anticoagulation&#46; Nevertheless&#44; there may be procedure-related complications such as device embolization and left atrial wall perforation&#46; The close relationship between the LAA and circumflex artery place this latter structure and its branches &#40;including the sinus node artery in 30&#37; of patients&#41; at risk during the procedure&#46; This condition must be considered if the patient develops atrial arrhythmias or signs of myocardial ischemia during the procedure&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical disclosures</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of human and animal subjects</span><p id="par0015" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Confidentiality of data</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Selective angiography of the left atrial appendage using a pigtail catheter shows the relationship between this structure &#40;asterisk&#41; and the stents previously implanted in the mid-circumflex artery &#40;arrow&#41;&#46;</p>"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Intraoperative monitoring of deployment of the Amplatzer device by transesophageal echocardiography &#40;A&#8211;D&#41;&#46; Stents previously placed in the circumflex artery &#40;yellow arrows&#41; can be seen in the vicinity of the left atrial appendage&#44; immediately next to the device landing zone&#46;</p>"
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">After the Amplatzer was completely deployed&#44; radioscopy confirmed the relationship between the distal lobe of the device and the coronary artery&#46; Although in this patient this latter structure was easily delineated by the previously implanted stents&#44; it is vital to consider this anatomical relationship during the occlusion procedure&#46;</p>"
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Informação do artigo
ISSN: 08702551
Idioma original: Inglês
DOI:10.1016/j.repc.2015.05.002
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