array:25 [
  "pii" => "S0870255117305607"
  "issn" => "08702551"
  "doi" => "10.1016/j.repc.2016.08.014"
  "estado" => "S300"
  "fechaPublicacion" => "2017-09-01"
  "aid" => "1048"
  "copyright" => "Sociedade Portuguesa de Cardiologia"
  "copyrightAnyo" => "2017"
  "documento" => "simple-article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "crp"
  "cita" => "Rev Port Cardiol. 2017;36:671.e1-4"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 2114
    "formatos" => array:3 [
      "EPUB" => 165
      "HTML" => 1557
      "PDF" => 392
    ]
  ]
  "Traduccion" => array:1 [
    "en" => array:20 [
      "pii" => "S2174204917302453"
      "issn" => "21742049"
      "doi" => "10.1016/j.repce.2016.08.011"
      "estado" => "S300"
      "fechaPublicacion" => "2017-09-01"
      "aid" => "1048"
      "copyright" => "Sociedade Portuguesa de Cardiologia"
      "documento" => "simple-article"
      "crossmark" => 1
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "crp"
      "cita" => "Rev Port Cardiol. 2017;36:671.e1-4"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 1350
        "formatos" => array:3 [
          "EPUB" => 137
          "HTML" => 924
          "PDF" => 289
        ]
      ]
      "en" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>"
        "titulo" => "Missing grafts and the potential for inappropriate revascularization"
        "tienePdf" => "en"
        "tieneTextoCompleto" => "en"
        "tieneResumen" => array:2 [
          0 => "en"
          1 => "pt"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "671&#46;e1"
            "paginaFinal" => "671&#46;e4"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "pt" => array:1 [
            "titulo" => "Falta de enxertos e o potencial de uma revasculariza&#231;&#227;o inapropriada"
          ]
        ]
        "contieneResumen" => array:2 [
          "en" => true
          "pt" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "en" => true
        ]
        "contienePdf" => array:1 [
          "en" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0005"
            "etiqueta" => "Figure 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 644
                "Ancho" => 1800
                "Tamanyo" => 127648
              ]
            ]
            "descripcion" => array:1 [
              "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Saphenous vein graft stump occluded with fresh thrombus&#59; &#40;B&#41; SVG after successful intervention&#46; RCA&#58; right coronary artery&#59; SVG&#58; saphenous vein graft&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Oluwaseyi Bolorunduro, Mohamed Morsy, Yaser Cheema, Rami N&#46; Khouzam"
            "autores" => array:4 [
              0 => array:2 [
                "nombre" => "Oluwaseyi"
                "apellidos" => "Bolorunduro"
              ]
              1 => array:2 [
                "nombre" => "Mohamed"
                "apellidos" => "Morsy"
              ]
              2 => array:2 [
                "nombre" => "Yaser"
                "apellidos" => "Cheema"
              ]
              3 => array:2 [
                "nombre" => "Rami N&#46;"
                "apellidos" => "Khouzam"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "en"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S0870255117305607"
          "doi" => "10.1016/j.repc.2016.08.014"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117305607?idApp=UINPBA00004E"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917302453?idApp=UINPBA00004E"
      "url" => "/21742049/0000003600000009/v1_201709220127/S2174204917302453/v1_201709220127/en/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S0870255117305681"
    "issn" => "08702551"
    "doi" => "10.1016/j.repc.2016.09.022"
    "estado" => "S300"
    "fechaPublicacion" => "2017-09-01"
    "aid" => "1052"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "sco"
    "cita" => "Rev Port Cardiol. 2017;36:673-4"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 1807
      "formatos" => array:3 [
        "EPUB" => 146
        "HTML" => 1281
        "PDF" => 380
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Image in Cardiology</span>"
      "titulo" => "Fetal giant cardiac tumor"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "673"
          "paginaFinal" => "674"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Tumor card&#237;aco gigante no feto"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1035
              "Ancho" => 2500
              "Tamanyo" => 270972
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Fetal echocardiogram at 35 weeks of gestation &#40;4-chamber view&#41;&#58; single cardiac mass adjacent to the left ventricle &#40;57 mm&#215;43 mm&#41;&#44; with well-defined contours and homogeneous echogenicity&#44; mild left ventricular compression and moderate pericardial effusion &#40;arrows&#41;&#46; LA&#58; left atrium&#59; LV&#58; left ventricle&#59; RA&#58; right atrium&#59; RV&#58; right ventricle&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "In&#234;s C&#46; Mendes, Ana Rita Ara&#250;jo, Rui Anjos, Ana Teixeira"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "In&#234;s C&#46;"
              "apellidos" => "Mendes"
            ]
            1 => array:2 [
              "nombre" => "Ana Rita"
              "apellidos" => "Ara&#250;jo"
            ]
            2 => array:2 [
              "nombre" => "Rui"
              "apellidos" => "Anjos"
            ]
            3 => array:2 [
              "nombre" => "Ana"
              "apellidos" => "Teixeira"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S2174204917302465"
        "doi" => "10.1016/j.repce.2016.09.018"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917302465?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117305681?idApp=UINPBA00004E"
    "url" => "/08702551/0000003600000009/v1_201709150927/S0870255117305681/v1_201709150927/en/main.assets"
  ]
  "itemAnterior" => array:20 [
    "pii" => "S0870255117305590"
    "issn" => "08702551"
    "doi" => "10.1016/j.repc.2016.07.018"
    "estado" => "S300"
    "fechaPublicacion" => "2017-09-01"
    "aid" => "1047"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "simple-article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "crp"
    "cita" => "Rev Port Cardiol. 2017;36:669&#46;e1-4"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 1999
      "formatos" => array:3 [
        "EPUB" => 172
        "HTML" => 1363
        "PDF" => 464
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>"
      "titulo" => "Complex phenotype linked to a mutation in exon 11 of the lamin A&#47;C gene&#58; Hypertrophic cardiomyopathy&#44; atrioventricular block&#44; severe dyslipidemia and diabetes"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "pt"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "669&#46;e1"
          "paginaFinal" => "669&#46;e4"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Fen&#243;tipo complexo associado a uma muta&#231;&#227;o no ex&#227;o 11 do gene da l&#226;mina A&#47;C&#58; miocardiopatia hipertr&#243;fica&#44; bloqueio auriculoventricular&#44; dislipidemia grave e diabetes <span class="elsevierStyleItalic">mellitus</span>"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "pt" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Ana Rita G&#46; Francisco, In&#234;s Santos Gon&#231;alves, F&#225;tima Veiga, M&#243;nica Mendes Pedro, Fausto J&#46; Pinto, Dulce Brito"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "Ana Rita G&#46;"
              "apellidos" => "Francisco"
            ]
            1 => array:2 [
              "nombre" => "In&#234;s"
              "apellidos" => "Santos Gon&#231;alves"
            ]
            2 => array:2 [
              "nombre" => "F&#225;tima"
              "apellidos" => "Veiga"
            ]
            3 => array:2 [
              "nombre" => "M&#243;nica"
              "apellidos" => "Mendes Pedro"
            ]
            4 => array:2 [
              "nombre" => "Fausto J&#46;"
              "apellidos" => "Pinto"
            ]
            5 => array:2 [
              "nombre" => "Dulce"
              "apellidos" => "Brito"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S2174204917302441"
        "doi" => "10.1016/j.repce.2017.09.002"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917302441?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117305590?idApp=UINPBA00004E"
    "url" => "/08702551/0000003600000009/v1_201709150927/S0870255117305590/v1_201709150927/en/main.assets"
  ]
  "en" => array:19 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>"
    "titulo" => "Missing grafts and the potential for inappropriate revascularization"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "671&#46;e1"
        "paginaFinal" => "671&#46;e4"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Oluwaseyi Bolorunduro, Mohamed Morsy, Yaser Cheema, Rami N&#46; Khouzam"
        "autores" => array:4 [
          0 => array:2 [
            "nombre" => "Oluwaseyi"
            "apellidos" => "Bolorunduro"
          ]
          1 => array:2 [
            "nombre" => "Mohamed"
            "apellidos" => "Morsy"
          ]
          2 => array:2 [
            "nombre" => "Yaser"
            "apellidos" => "Cheema"
          ]
          3 => array:4 [
            "nombre" => "Rami N&#46;"
            "apellidos" => "Khouzam"
            "email" => array:1 [
              0 => "khouzamrami&#64;yahoo&#46;com"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Department of Medicine&#44; Division of Cardiovascular Diseases&#44; University of Tennessee Health Science Center&#44; Memphis&#44; TN&#44; United States"
            "identificador" => "aff0005"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "pt" => array:1 [
        "titulo" => "Falta de enxertos e o potencial de uma revasculariza&#231;&#227;o inapropriada"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 2762
            "Ancho" => 3000
            "Tamanyo" => 463688
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Case B showing an aortogram with no grafts visualized&#59; &#40;B&#41; case B showing widely patent saphenous vein graft&#59; &#40;C&#41; case C showing occluded SVG graft&#59; &#40;D&#41; case C showing SVG graft after successful intervention&#46; SVG&#58; saphenous vein graft&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Management of coronary artery disease &#40;CAD&#41; after coronary artery bypass grafting &#40;CABG&#41; is multifaceted&#46; Due to the adverse risk factor profile of these patients&#44; there is frequently significant progression of atherosclerosis in the native vessels and grafts requiring future invasive procedures&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> Coronary intervention in this population is more complex&#44; making knowledge of prior coronary anatomy essential for achieving excellent outcomes&#46; This information is not always available&#44; as many cases present emergently as ST-elevation myocardial infarction &#40;STEMI&#41;&#44; therefore emergent intervention is performed without complete data&#46; This has led to some inappropriate revascularizations with the attendant risk of major complications&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">We highlight this highly under-reported problem and suggest management techniques to help mitigate the risk&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case reports</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Case A</span><p id="par0015" class="elsevierStylePara elsevierViewall">A 74-year-old male had a history of hypertension and CAD with previous CABG&#44; including left internal mammary &#40;LIMA&#41; to left anterior descending &#40;LAD&#41;&#44; saphenous vein graft &#40;SVG&#41; to posterolateral &#40;PL&#41; branch&#44; SVG to first diagonal and SVG to posterior descending artery &#40;PDA&#41;&#46; He developed chest pain and presented with an inferior wall STEMI&#46; Per a previous angiogram performed at another hospital&#44; his SVG to PDA graft was considered chronically occluded&#46; Emergent cardiac catheterization revealed significant native multivessel disease&#46; The LIMA-LAD&#44; SVG-PL and SVG-diagonal grafts were all widely patent&#46; The SVG to PDA graft was totally occluded proximally with fresh thrombi &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A&#41;&#46; As this graft had an ostial stent protruding about 5 mm into the aorta&#44; cannulation was difficult&#44; and required a multipurpose guide catheter&#46; Intravascular ultrasound was used to properly characterize this lesion&#44; then aspiration thrombectomy of a fresh thrombus was successfully performed &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>B&#41; followed by placement of a drug-eluting stent&#46; In retrospect&#44; this graft had been considered totally occluded on a previous angiogram&#44; probably due to the difficulty of cannulation&#46; Proper engagement of the graft this time spared the patient significant myocardial damage that might have resulted from not intervening on this culprit artery&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Case B</span><p id="par0020" class="elsevierStylePara elsevierViewall">A 70-year-old female with a history of CAD and previous CABG &#40;LIMA-LAD&#44; SVG-OM&#41;&#44; peripheral vascular disease&#44; diabetes&#44; hypertension&#44; and hyperlipidemia was admitted eight months after CABG with an acute non-ST-elevation myocardial infarction &#40;NSTEMI&#41;&#44; with troponin I of 8 ng&#47;ml &#40;normal&#58; 0&#46;0-0&#46;04&#41;&#46; Cardiac catheterization revealed significant native LAD and left circumflex &#40;LCx&#41; disease&#46; The LIMA-LAD graft was patent&#44; and since an extensive search including aortography revealed no other patent grafts &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>A&#41;&#44; it was assumed that the SVG-OM was occluded&#46; Consequently&#44; percutaneous transluminal balloon angioplasty and stenting of the native LCx&#47;OM was performed&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Seven months later&#44; she was readmitted with angina and a positive nuclear stress test suggestive of inferolateral ischemia&#46; Repeat cardiac catheterization this time using an AL1 catheter showed a widely patent SVG-OM graft with good distal runoff &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>B&#41;&#46; Medical therapy was optimized&#46; It was concluded that the SVG-OM was missed during the previous cardiac catheterization&#44; possibly leading to unnecessary intervention on the native LCx&#46; This could have potentially led to competitive flow and subsequent closure of a patent graft&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Case C</span><p id="par0030" class="elsevierStylePara elsevierViewall">A 52-year-old male had a history of CAD and previous CABG &#40;LIMA-LAD&#44; SVG-PDA&#44; SVG-OM&#41;&#46; On admission for NSTEMI&#44; cardiac catheterization revealed a patent LIMA-LAD&#44; an occluded SVG-OM&#44; and 90&#37; stenosis of the SVG-PDA&#44; for which he received a stent&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Two years later&#44; he presented with another NSTEMI &#40;troponin I 8&#46;5 ng&#47;ml &#91;normal&#58; 0&#46;0-0&#46;04&#93;&#41;&#46; This time the SVG-PDA was considered totally occluded and optimized medical management was offered&#46; On another admission for NSTEMI and worsening LV dysfunction&#44; his ejection fraction dropped from 45&#37; to 20&#37;&#44; and another cardiac catheterization showed that the SVG-PDA was not totally occluded as assumed previously&#44; but was rather 99&#37; stenosed ostially &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>C&#41;&#46; Selective engagement was achieved using a multipurpose catheter with gentle manipulation followed by angioplasty and successful stent placement&#44; with restoration of TIMI 3 flow &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>D&#41;&#46; In this case&#44; we can speculate that a timely intervention on this lesion could have avoided the drop in left ventricular function&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">These three cases highlight the importance of accurate graft localization during coronary angiography of patients with prior CABG&#46; The phenomenon of missing grafts and inappropriate revascularization during emergent angiography is under-reported and a meticulous literature search failed to reveal any reports commenting on its incidence or prevalence&#46; It is a common situation that many interventional cardiologists face when treating patients with prior CABG and can lead to suboptimal management and outcome&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">It is extremely important to have the prior operative and angiography report in order to prepare a plan and road map prior to intervention&#44; but unfortunately this is not always available&#44; especially in emergent situations&#46; Also&#44; even if the cardiac catheterization report is available with the patient or in their chart&#44; this would not be as helpful as reviewing images and films that can give clues regarding anatomy beyond what is only reported&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Various methods have been used to identify bypass grafts&#46; In the past&#44; surgeons marked the ostia of vein grafts with radio-opaque rings&#44; substantially aiding the angiographer to localize the vein graft ostia during angiography&#46; However&#44; nowadays this is not a common practice&#46; The use of different catheters other than the usual JR4&#44; such as Amplatz multipurpose&#44; AL1&#44; AL2&#44; or AR catheters or others according to the nature of the unusual takeoff of vein grafts&#44; is important&#46; Often&#44; a non-selective aortogram is the only option to either identify the ostium of the graft or to label a graft as totally occluded&#46; In our three cases&#44; we had the previous aortogram that did not show stumps or residual knobs&#44; and unfortunately there was no vein markers present&#46; Only repeated systematic search for the grafts aided in their identification in the subsequent angiogram&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Given the potential consequences of falsely labeling missing grafts as occluded&#44; we propose taking adjunctive measures to increase the specificity of diagnosis before a graft is considered occluded&#46; The role of non-invasive imaging in the evaluation of bypass grafts has been well studied&#46; The American College of Cardiology endorses the use of multidetector computed tomography coronary angiography &#40;CTCA&#41; to assess graft patency after CABG&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> CTCA has a positive predictive value of 97-99&#37; in assessing graft patency and stenosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">3&#8211;5</span></a> As per the 2010 appropriate use criteria for cardiac computed tomography&#44; CCTA evaluation of graft patency for symptomatic patients after CABG is considered appropriate with a score of A &#40;8&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> However&#44; we did not use CCTA in any of our cases as in our institution we do not have easy access to CCTA for inpatients&#44; and specifically there is no protocol for inpatient service presenting with acute coronary syndrome&#46; Its use as an adjunct to conventional coronary angiogram in patients with missing grafts can be beneficial&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">It might be assumed that these errors would only be found among relatively inexperienced operators&#44; but the three operators in these cases each had an average 15 years of post-interventional cardiology training experience&#46; There is no published study highlighting the frequency of missed grafts during cardiac catheterization&#44; but from anecdotal reports it is not uncommon&#46; This study is very important especially in the light of the Institute of Medicine&#39;s &#8220;To err is human&#8221; report&#44; which emphasizes the need for physicians to undergo continuous process improvement through internal systems reviews&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusion</span><p id="par0065" class="elsevierStylePara elsevierViewall">We present a series of cases highlighting an important yet seriously under-reported conundrum&#46; Interventionists are performing more emergent angiograms on post-CABG patients without having adequate background information on their coronary anatomy and grafts&#46; The consequences of falsely labeling missed grafts as occluded are dire&#46; In order to avoid inappropriate revascularization&#44; we propose a thorough search for grafts with different catheters&#44; aortogram and&#44; if needed&#44; CTCA as a complement to routine angiography to improve diagnostic specificity when bypass grafts are initially considered occluded&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Ethical disclosures</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Protection of human and animal subjects</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Confidentiality of data</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Right to privacy and informed consent</span><p id="par0080" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conflicts of interest</span><p id="par0085" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:11 [
        0 => array:3 [
          "identificador" => "xres901297"
          "titulo" => "Abstract"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0005"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec882332"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres901298"
          "titulo" => "Resumo"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0010"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec882333"
          "titulo" => "Palavras-chave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Case reports"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Case A"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Case B"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Case C"
            ]
          ]
        ]
        6 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Discussion"
        ]
        7 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Conclusion"
        ]
        8 => array:3 [
          "identificador" => "sec0040"
          "titulo" => "Ethical disclosures"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Protection of human and animal subjects"
            ]
            1 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Confidentiality of data"
            ]
            2 => array:2 [
              "identificador" => "sec0055"
              "titulo" => "Right to privacy and informed consent"
            ]
          ]
        ]
        9 => array:2 [
          "identificador" => "sec0060"
          "titulo" => "Conflicts of interest"
        ]
        10 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2016-04-16"
    "fechaAceptado" => "2016-08-26"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec882332"
          "palabras" => array:3 [
            0 => "Myocardial infarction"
            1 => "Missed grafts"
            2 => "Coronary artery bypass graft"
          ]
        ]
      ]
      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec882333"
          "palabras" => array:3 [
            0 => "Enfarte do mioc&#225;rdio"
            1 => "Falta de enxertos"
            2 => "Cirurgia de revasculariza&#231;&#227;o do mioc&#225;rdio"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The best outcome for coronary intervention in coronary artery bypass graft patients requires knowledge of prior coronary anatomy&#46; This information is not always available as many cases present acutely&#44; especially in ST-elevation myocardial infarction&#46; We present three cases in which bypass grafts were documented as occluded but follow-up angiograms for other reasons revealed that the grafts were still patent&#46; This presents the potential for inappropriate revascularizations&#46;</p></span>"
      ]
      "pt" => array:2 [
        "titulo" => "Resumo"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">O melhor resultado da interven&#231;&#227;o coron&#225;ria nos doentes submetidos a cirurgia de revasculariza&#231;&#227;o do mioc&#225;rdio requer conhecimento da anatomia coron&#225;ria anterior&#46; Tal informa&#231;&#227;o nem sempre est&#225; dispon&#237;vel&#44; uma vez que muitos casos apresentam-se agudos&#44; em particular nos enfartes do mioc&#225;rdio com eleva&#231;&#227;o do segmento ST&#46; Apresentamos tr&#234;s casos em que foram referidos enxertos oclu&#237;dos&#44; mas os angiogramas de seguimento&#44; por outros motivos&#44; revelaram que os enxertos ainda estavam patentes&#46; Tal comprova o potencial de revasculariza&#231;&#245;es inapropriadas&#46;</p></span>"
      ]
    ]
    "multimedia" => array:2 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 644
            "Ancho" => 1800
            "Tamanyo" => 127648
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Saphenous vein graft stump occluded with fresh thrombus&#59; &#40;B&#41; SVG after successful intervention&#46; RCA&#58; right coronary artery&#59; SVG&#58; saphenous vein graft&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 2762
            "Ancho" => 3000
            "Tamanyo" => 463688
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Case B showing an aortogram with no grafts visualized&#59; &#40;B&#41; case B showing widely patent saphenous vein graft&#59; &#40;C&#41; case C showing occluded SVG graft&#59; &#40;D&#41; case C showing SVG graft after successful intervention&#46; SVG&#58; saphenous vein graft&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:6 [
            0 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Atherosclerosis and late closure of aortocoronary saphenous vein grafts&#58; sequential angiographic studies at 2 weeks&#44; 1 year&#44; 5 to 7 years&#44; and 10 to 12 years after surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "L&#46; Campeau"
                            1 => "M&#46; Enjalbert"
                            2 => "J&#46; Lesperance"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "1983"
                        "volumen" => "68"
                        "paginaInicial" => "II1"
                        "paginaFinal" => "II7"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6603280"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0735109706030257"
                          "estado" => "S300"
                          "issn" => "07351097"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "ACCF&#47;SCCT&#47;ACR&#47;AHA&#47;ASE&#47;ASNC&#47;NASCI&#47;SCAI&#47;SCMR 2010 appropriate use criteria for cardiac computed tomography&#46; A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force&#44; the Society of Cardiovascular Computed Tomography&#44; the American College of Radiology&#44; the American Heart Association&#44; the American Society of Echocardiography&#44; the American Society of Nuclear Cardiology&#44; the North American Society for Cardiovascular Imaging&#44; the Society for Cardiovascular Angiography and Interventions&#44; and the Society for Cardiovascular Magnetic Resonance"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46;J&#46; Taylor"
                            1 => "M&#46; Cerqueira"
                            2 => "J&#46;M&#46; Hodgson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIR.0b013e3181fcae66"
                      "Revista" => array:7 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2010"
                        "volumen" => "122"
                        "paginaInicial" => "e525"
                        "paginaFinal" => "e555"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20975004"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S073510971302929X"
                          "estado" => "S300"
                          "issn" => "07351097"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Improved noninvasive assessment of coronary artery bypass grafts with 64-slice computed tomographic angiography in an unselected patient population"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "T&#46;S&#46; Meyer"
                            1 => "S&#46; Martinoff"
                            2 => "M&#46; Hadamitzky"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2006.10.066"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2007"
                        "volumen" => "49"
                        "paginaInicial" => "946"
                        "paginaFinal" => "950"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17336717"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Non-invasive assessment of coronary artery bypass grafts by computed tomography&#58; comparison with conventional coronary angiography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46; Trigo Bautista"
                            1 => "J&#46; Estornell"
                            2 => "F&#46; Ridocci"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Esp Cardiol"
                        "fecha" => "2005"
                        "volumen" => "58"
                        "paginaInicial" => "807"
                        "paginaFinal" => "814"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16022812"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Does CT coronary angiography have a role in the evaluation of patients with CABG&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Albarjas"
                            1 => "K&#46; Alfakih"
                            2 => "J&#46; Hill"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Br J Cardiol"
                        "fecha" => "2012"
                        "volumen" => "19"
                        "paginaInicial" => "139"
                        "paginaFinal" => "140"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "To err is human&#58; building a safer health system"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Institute of Medicine &#40;US&#41; Committee on Quality of Health Care in America"
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46;T&#46; Kohn"
                            1 => "J&#46;M&#46; Corrigan"
                            2 => "M&#46;S&#46; Donaldson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2000"
                        "editorial" => "National Academies Press &#40;US&#41;"
                        "editorialLocalizacion" => "Washington &#40;DC&#41;"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/08702551/0000003600000009/v1_201709150927/S0870255117305607/v1_201709150927/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "29263"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Casos Cl&#237;nicos"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/08702551/0000003600000009/v1_201709150927/S0870255117305607/v1_201709150927/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117305607?idApp=UINPBA00004E"
]
Partilhar
Informação da revista

Estatísticas

Siga este link para acessar o texto completo do artigo

Case report
Missing grafts and the potential for inappropriate revascularization
Falta de enxertos e o potencial de uma revascularização inapropriada
Oluwaseyi Bolorunduro, Mohamed Morsy, Yaser Cheema, Rami N. Khouzam
Autor para correspondência
khouzamrami@yahoo.com

Corresponding author.
Department of Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, United States
Lido
5882
Vezes
que se leu este artigo
1730
Total PDF
4152
Total HTML
Compartilhar estatísticas
 array:25 [
  "pii" => "S0870255117305607"
  "issn" => "08702551"
  "doi" => "10.1016/j.repc.2016.08.014"
  "estado" => "S300"
  "fechaPublicacion" => "2017-09-01"
  "aid" => "1048"
  "copyright" => "Sociedade Portuguesa de Cardiologia"
  "copyrightAnyo" => "2017"
  "documento" => "simple-article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "crp"
  "cita" => "Rev Port Cardiol. 2017;36:671&#46;e1-4"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 2114
    "formatos" => array:3 [
      "EPUB" => 165
      "HTML" => 1557
      "PDF" => 392
    ]
  ]
  "Traduccion" => array:1 [
    "en" => array:20 [
      "pii" => "S2174204917302453"
      "issn" => "21742049"
      "doi" => "10.1016/j.repce.2016.08.011"
      "estado" => "S300"
      "fechaPublicacion" => "2017-09-01"
      "aid" => "1048"
      "copyright" => "Sociedade Portuguesa de Cardiologia"
      "documento" => "simple-article"
      "crossmark" => 1
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "crp"
      "cita" => "Rev Port Cardiol. 2017;36:671&#46;e1-4"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 1350
        "formatos" => array:3 [
          "EPUB" => 137
          "HTML" => 924
          "PDF" => 289
        ]
      ]
      "en" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>"
        "titulo" => "Missing grafts and the potential for inappropriate revascularization"
        "tienePdf" => "en"
        "tieneTextoCompleto" => "en"
        "tieneResumen" => array:2 [
          0 => "en"
          1 => "pt"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "671&#46;e1"
            "paginaFinal" => "671&#46;e4"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "pt" => array:1 [
            "titulo" => "Falta de enxertos e o potencial de uma revasculariza&#231;&#227;o inapropriada"
          ]
        ]
        "contieneResumen" => array:2 [
          "en" => true
          "pt" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "en" => true
        ]
        "contienePdf" => array:1 [
          "en" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0005"
            "etiqueta" => "Figure 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 644
                "Ancho" => 1800
                "Tamanyo" => 127648
              ]
            ]
            "descripcion" => array:1 [
              "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Saphenous vein graft stump occluded with fresh thrombus&#59; &#40;B&#41; SVG after successful intervention&#46; RCA&#58; right coronary artery&#59; SVG&#58; saphenous vein graft&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Oluwaseyi Bolorunduro, Mohamed Morsy, Yaser Cheema, Rami N&#46; Khouzam"
            "autores" => array:4 [
              0 => array:2 [
                "nombre" => "Oluwaseyi"
                "apellidos" => "Bolorunduro"
              ]
              1 => array:2 [
                "nombre" => "Mohamed"
                "apellidos" => "Morsy"
              ]
              2 => array:2 [
                "nombre" => "Yaser"
                "apellidos" => "Cheema"
              ]
              3 => array:2 [
                "nombre" => "Rami N&#46;"
                "apellidos" => "Khouzam"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "en"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S0870255117305607"
          "doi" => "10.1016/j.repc.2016.08.014"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117305607?idApp=UINPBA00004E"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917302453?idApp=UINPBA00004E"
      "url" => "/21742049/0000003600000009/v1_201709220127/S2174204917302453/v1_201709220127/en/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S0870255117305681"
    "issn" => "08702551"
    "doi" => "10.1016/j.repc.2016.09.022"
    "estado" => "S300"
    "fechaPublicacion" => "2017-09-01"
    "aid" => "1052"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "sco"
    "cita" => "Rev Port Cardiol. 2017;36:673-4"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 1807
      "formatos" => array:3 [
        "EPUB" => 146
        "HTML" => 1281
        "PDF" => 380
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Image in Cardiology</span>"
      "titulo" => "Fetal giant cardiac tumor"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "673"
          "paginaFinal" => "674"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Tumor card&#237;aco gigante no feto"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1035
              "Ancho" => 2500
              "Tamanyo" => 270972
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Fetal echocardiogram at 35 weeks of gestation &#40;4-chamber view&#41;&#58; single cardiac mass adjacent to the left ventricle &#40;57 mm&#215;43 mm&#41;&#44; with well-defined contours and homogeneous echogenicity&#44; mild left ventricular compression and moderate pericardial effusion &#40;arrows&#41;&#46; LA&#58; left atrium&#59; LV&#58; left ventricle&#59; RA&#58; right atrium&#59; RV&#58; right ventricle&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "In&#234;s C&#46; Mendes, Ana Rita Ara&#250;jo, Rui Anjos, Ana Teixeira"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "In&#234;s C&#46;"
              "apellidos" => "Mendes"
            ]
            1 => array:2 [
              "nombre" => "Ana Rita"
              "apellidos" => "Ara&#250;jo"
            ]
            2 => array:2 [
              "nombre" => "Rui"
              "apellidos" => "Anjos"
            ]
            3 => array:2 [
              "nombre" => "Ana"
              "apellidos" => "Teixeira"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S2174204917302465"
        "doi" => "10.1016/j.repce.2016.09.018"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917302465?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117305681?idApp=UINPBA00004E"
    "url" => "/08702551/0000003600000009/v1_201709150927/S0870255117305681/v1_201709150927/en/main.assets"
  ]
  "itemAnterior" => array:20 [
    "pii" => "S0870255117305590"
    "issn" => "08702551"
    "doi" => "10.1016/j.repc.2016.07.018"
    "estado" => "S300"
    "fechaPublicacion" => "2017-09-01"
    "aid" => "1047"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "simple-article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "crp"
    "cita" => "Rev Port Cardiol. 2017;36:669&#46;e1-4"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 1999
      "formatos" => array:3 [
        "EPUB" => 172
        "HTML" => 1363
        "PDF" => 464
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>"
      "titulo" => "Complex phenotype linked to a mutation in exon 11 of the lamin A&#47;C gene&#58; Hypertrophic cardiomyopathy&#44; atrioventricular block&#44; severe dyslipidemia and diabetes"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "pt"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "669&#46;e1"
          "paginaFinal" => "669&#46;e4"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Fen&#243;tipo complexo associado a uma muta&#231;&#227;o no ex&#227;o 11 do gene da l&#226;mina A&#47;C&#58; miocardiopatia hipertr&#243;fica&#44; bloqueio auriculoventricular&#44; dislipidemia grave e diabetes <span class="elsevierStyleItalic">mellitus</span>"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "pt" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Ana Rita G&#46; Francisco, In&#234;s Santos Gon&#231;alves, F&#225;tima Veiga, M&#243;nica Mendes Pedro, Fausto J&#46; Pinto, Dulce Brito"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "Ana Rita G&#46;"
              "apellidos" => "Francisco"
            ]
            1 => array:2 [
              "nombre" => "In&#234;s"
              "apellidos" => "Santos Gon&#231;alves"
            ]
            2 => array:2 [
              "nombre" => "F&#225;tima"
              "apellidos" => "Veiga"
            ]
            3 => array:2 [
              "nombre" => "M&#243;nica"
              "apellidos" => "Mendes Pedro"
            ]
            4 => array:2 [
              "nombre" => "Fausto J&#46;"
              "apellidos" => "Pinto"
            ]
            5 => array:2 [
              "nombre" => "Dulce"
              "apellidos" => "Brito"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S2174204917302441"
        "doi" => "10.1016/j.repce.2017.09.002"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917302441?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117305590?idApp=UINPBA00004E"
    "url" => "/08702551/0000003600000009/v1_201709150927/S0870255117305590/v1_201709150927/en/main.assets"
  ]
  "en" => array:19 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>"
    "titulo" => "Missing grafts and the potential for inappropriate revascularization"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "671&#46;e1"
        "paginaFinal" => "671&#46;e4"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Oluwaseyi Bolorunduro, Mohamed Morsy, Yaser Cheema, Rami N&#46; Khouzam"
        "autores" => array:4 [
          0 => array:2 [
            "nombre" => "Oluwaseyi"
            "apellidos" => "Bolorunduro"
          ]
          1 => array:2 [
            "nombre" => "Mohamed"
            "apellidos" => "Morsy"
          ]
          2 => array:2 [
            "nombre" => "Yaser"
            "apellidos" => "Cheema"
          ]
          3 => array:4 [
            "nombre" => "Rami N&#46;"
            "apellidos" => "Khouzam"
            "email" => array:1 [
              0 => "khouzamrami&#64;yahoo&#46;com"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Department of Medicine&#44; Division of Cardiovascular Diseases&#44; University of Tennessee Health Science Center&#44; Memphis&#44; TN&#44; United States"
            "identificador" => "aff0005"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "pt" => array:1 [
        "titulo" => "Falta de enxertos e o potencial de uma revasculariza&#231;&#227;o inapropriada"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 2762
            "Ancho" => 3000
            "Tamanyo" => 463688
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Case B showing an aortogram with no grafts visualized&#59; &#40;B&#41; case B showing widely patent saphenous vein graft&#59; &#40;C&#41; case C showing occluded SVG graft&#59; &#40;D&#41; case C showing SVG graft after successful intervention&#46; SVG&#58; saphenous vein graft&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Management of coronary artery disease &#40;CAD&#41; after coronary artery bypass grafting &#40;CABG&#41; is multifaceted&#46; Due to the adverse risk factor profile of these patients&#44; there is frequently significant progression of atherosclerosis in the native vessels and grafts requiring future invasive procedures&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> Coronary intervention in this population is more complex&#44; making knowledge of prior coronary anatomy essential for achieving excellent outcomes&#46; This information is not always available&#44; as many cases present emergently as ST-elevation myocardial infarction &#40;STEMI&#41;&#44; therefore emergent intervention is performed without complete data&#46; This has led to some inappropriate revascularizations with the attendant risk of major complications&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">We highlight this highly under-reported problem and suggest management techniques to help mitigate the risk&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case reports</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Case A</span><p id="par0015" class="elsevierStylePara elsevierViewall">A 74-year-old male had a history of hypertension and CAD with previous CABG&#44; including left internal mammary &#40;LIMA&#41; to left anterior descending &#40;LAD&#41;&#44; saphenous vein graft &#40;SVG&#41; to posterolateral &#40;PL&#41; branch&#44; SVG to first diagonal and SVG to posterior descending artery &#40;PDA&#41;&#46; He developed chest pain and presented with an inferior wall STEMI&#46; Per a previous angiogram performed at another hospital&#44; his SVG to PDA graft was considered chronically occluded&#46; Emergent cardiac catheterization revealed significant native multivessel disease&#46; The LIMA-LAD&#44; SVG-PL and SVG-diagonal grafts were all widely patent&#46; The SVG to PDA graft was totally occluded proximally with fresh thrombi &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A&#41;&#46; As this graft had an ostial stent protruding about 5 mm into the aorta&#44; cannulation was difficult&#44; and required a multipurpose guide catheter&#46; Intravascular ultrasound was used to properly characterize this lesion&#44; then aspiration thrombectomy of a fresh thrombus was successfully performed &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>B&#41; followed by placement of a drug-eluting stent&#46; In retrospect&#44; this graft had been considered totally occluded on a previous angiogram&#44; probably due to the difficulty of cannulation&#46; Proper engagement of the graft this time spared the patient significant myocardial damage that might have resulted from not intervening on this culprit artery&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Case B</span><p id="par0020" class="elsevierStylePara elsevierViewall">A 70-year-old female with a history of CAD and previous CABG &#40;LIMA-LAD&#44; SVG-OM&#41;&#44; peripheral vascular disease&#44; diabetes&#44; hypertension&#44; and hyperlipidemia was admitted eight months after CABG with an acute non-ST-elevation myocardial infarction &#40;NSTEMI&#41;&#44; with troponin I of 8 ng&#47;ml &#40;normal&#58; 0&#46;0-0&#46;04&#41;&#46; Cardiac catheterization revealed significant native LAD and left circumflex &#40;LCx&#41; disease&#46; The LIMA-LAD graft was patent&#44; and since an extensive search including aortography revealed no other patent grafts &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>A&#41;&#44; it was assumed that the SVG-OM was occluded&#46; Consequently&#44; percutaneous transluminal balloon angioplasty and stenting of the native LCx&#47;OM was performed&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Seven months later&#44; she was readmitted with angina and a positive nuclear stress test suggestive of inferolateral ischemia&#46; Repeat cardiac catheterization this time using an AL1 catheter showed a widely patent SVG-OM graft with good distal runoff &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>B&#41;&#46; Medical therapy was optimized&#46; It was concluded that the SVG-OM was missed during the previous cardiac catheterization&#44; possibly leading to unnecessary intervention on the native LCx&#46; This could have potentially led to competitive flow and subsequent closure of a patent graft&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Case C</span><p id="par0030" class="elsevierStylePara elsevierViewall">A 52-year-old male had a history of CAD and previous CABG &#40;LIMA-LAD&#44; SVG-PDA&#44; SVG-OM&#41;&#46; On admission for NSTEMI&#44; cardiac catheterization revealed a patent LIMA-LAD&#44; an occluded SVG-OM&#44; and 90&#37; stenosis of the SVG-PDA&#44; for which he received a stent&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Two years later&#44; he presented with another NSTEMI &#40;troponin I 8&#46;5 ng&#47;ml &#91;normal&#58; 0&#46;0-0&#46;04&#93;&#41;&#46; This time the SVG-PDA was considered totally occluded and optimized medical management was offered&#46; On another admission for NSTEMI and worsening LV dysfunction&#44; his ejection fraction dropped from 45&#37; to 20&#37;&#44; and another cardiac catheterization showed that the SVG-PDA was not totally occluded as assumed previously&#44; but was rather 99&#37; stenosed ostially &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>C&#41;&#46; Selective engagement was achieved using a multipurpose catheter with gentle manipulation followed by angioplasty and successful stent placement&#44; with restoration of TIMI 3 flow &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>D&#41;&#46; In this case&#44; we can speculate that a timely intervention on this lesion could have avoided the drop in left ventricular function&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">These three cases highlight the importance of accurate graft localization during coronary angiography of patients with prior CABG&#46; The phenomenon of missing grafts and inappropriate revascularization during emergent angiography is under-reported and a meticulous literature search failed to reveal any reports commenting on its incidence or prevalence&#46; It is a common situation that many interventional cardiologists face when treating patients with prior CABG and can lead to suboptimal management and outcome&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">It is extremely important to have the prior operative and angiography report in order to prepare a plan and road map prior to intervention&#44; but unfortunately this is not always available&#44; especially in emergent situations&#46; Also&#44; even if the cardiac catheterization report is available with the patient or in their chart&#44; this would not be as helpful as reviewing images and films that can give clues regarding anatomy beyond what is only reported&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Various methods have been used to identify bypass grafts&#46; In the past&#44; surgeons marked the ostia of vein grafts with radio-opaque rings&#44; substantially aiding the angiographer to localize the vein graft ostia during angiography&#46; However&#44; nowadays this is not a common practice&#46; The use of different catheters other than the usual JR4&#44; such as Amplatz multipurpose&#44; AL1&#44; AL2&#44; or AR catheters or others according to the nature of the unusual takeoff of vein grafts&#44; is important&#46; Often&#44; a non-selective aortogram is the only option to either identify the ostium of the graft or to label a graft as totally occluded&#46; In our three cases&#44; we had the previous aortogram that did not show stumps or residual knobs&#44; and unfortunately there was no vein markers present&#46; Only repeated systematic search for the grafts aided in their identification in the subsequent angiogram&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Given the potential consequences of falsely labeling missing grafts as occluded&#44; we propose taking adjunctive measures to increase the specificity of diagnosis before a graft is considered occluded&#46; The role of non-invasive imaging in the evaluation of bypass grafts has been well studied&#46; The American College of Cardiology endorses the use of multidetector computed tomography coronary angiography &#40;CTCA&#41; to assess graft patency after CABG&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> CTCA has a positive predictive value of 97-99&#37; in assessing graft patency and stenosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">3&#8211;5</span></a> As per the 2010 appropriate use criteria for cardiac computed tomography&#44; CCTA evaluation of graft patency for symptomatic patients after CABG is considered appropriate with a score of A &#40;8&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> However&#44; we did not use CCTA in any of our cases as in our institution we do not have easy access to CCTA for inpatients&#44; and specifically there is no protocol for inpatient service presenting with acute coronary syndrome&#46; Its use as an adjunct to conventional coronary angiogram in patients with missing grafts can be beneficial&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">It might be assumed that these errors would only be found among relatively inexperienced operators&#44; but the three operators in these cases each had an average 15 years of post-interventional cardiology training experience&#46; There is no published study highlighting the frequency of missed grafts during cardiac catheterization&#44; but from anecdotal reports it is not uncommon&#46; This study is very important especially in the light of the Institute of Medicine&#39;s &#8220;To err is human&#8221; report&#44; which emphasizes the need for physicians to undergo continuous process improvement through internal systems reviews&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusion</span><p id="par0065" class="elsevierStylePara elsevierViewall">We present a series of cases highlighting an important yet seriously under-reported conundrum&#46; Interventionists are performing more emergent angiograms on post-CABG patients without having adequate background information on their coronary anatomy and grafts&#46; The consequences of falsely labeling missed grafts as occluded are dire&#46; In order to avoid inappropriate revascularization&#44; we propose a thorough search for grafts with different catheters&#44; aortogram and&#44; if needed&#44; CTCA as a complement to routine angiography to improve diagnostic specificity when bypass grafts are initially considered occluded&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Ethical disclosures</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Protection of human and animal subjects</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Confidentiality of data</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Right to privacy and informed consent</span><p id="par0080" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conflicts of interest</span><p id="par0085" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:11 [
        0 => array:3 [
          "identificador" => "xres901297"
          "titulo" => "Abstract"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0005"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec882332"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres901298"
          "titulo" => "Resumo"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0010"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec882333"
          "titulo" => "Palavras-chave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Case reports"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Case A"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Case B"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Case C"
            ]
          ]
        ]
        6 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Discussion"
        ]
        7 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Conclusion"
        ]
        8 => array:3 [
          "identificador" => "sec0040"
          "titulo" => "Ethical disclosures"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Protection of human and animal subjects"
            ]
            1 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Confidentiality of data"
            ]
            2 => array:2 [
              "identificador" => "sec0055"
              "titulo" => "Right to privacy and informed consent"
            ]
          ]
        ]
        9 => array:2 [
          "identificador" => "sec0060"
          "titulo" => "Conflicts of interest"
        ]
        10 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2016-04-16"
    "fechaAceptado" => "2016-08-26"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec882332"
          "palabras" => array:3 [
            0 => "Myocardial infarction"
            1 => "Missed grafts"
            2 => "Coronary artery bypass graft"
          ]
        ]
      ]
      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec882333"
          "palabras" => array:3 [
            0 => "Enfarte do mioc&#225;rdio"
            1 => "Falta de enxertos"
            2 => "Cirurgia de revasculariza&#231;&#227;o do mioc&#225;rdio"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The best outcome for coronary intervention in coronary artery bypass graft patients requires knowledge of prior coronary anatomy&#46; This information is not always available as many cases present acutely&#44; especially in ST-elevation myocardial infarction&#46; We present three cases in which bypass grafts were documented as occluded but follow-up angiograms for other reasons revealed that the grafts were still patent&#46; This presents the potential for inappropriate revascularizations&#46;</p></span>"
      ]
      "pt" => array:2 [
        "titulo" => "Resumo"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">O melhor resultado da interven&#231;&#227;o coron&#225;ria nos doentes submetidos a cirurgia de revasculariza&#231;&#227;o do mioc&#225;rdio requer conhecimento da anatomia coron&#225;ria anterior&#46; Tal informa&#231;&#227;o nem sempre est&#225; dispon&#237;vel&#44; uma vez que muitos casos apresentam-se agudos&#44; em particular nos enfartes do mioc&#225;rdio com eleva&#231;&#227;o do segmento ST&#46; Apresentamos tr&#234;s casos em que foram referidos enxertos oclu&#237;dos&#44; mas os angiogramas de seguimento&#44; por outros motivos&#44; revelaram que os enxertos ainda estavam patentes&#46; Tal comprova o potencial de revasculariza&#231;&#245;es inapropriadas&#46;</p></span>"
      ]
    ]
    "multimedia" => array:2 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 644
            "Ancho" => 1800
            "Tamanyo" => 127648
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Saphenous vein graft stump occluded with fresh thrombus&#59; &#40;B&#41; SVG after successful intervention&#46; RCA&#58; right coronary artery&#59; SVG&#58; saphenous vein graft&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 2762
            "Ancho" => 3000
            "Tamanyo" => 463688
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Case B showing an aortogram with no grafts visualized&#59; &#40;B&#41; case B showing widely patent saphenous vein graft&#59; &#40;C&#41; case C showing occluded SVG graft&#59; &#40;D&#41; case C showing SVG graft after successful intervention&#46; SVG&#58; saphenous vein graft&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:6 [
            0 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Atherosclerosis and late closure of aortocoronary saphenous vein grafts&#58; sequential angiographic studies at 2 weeks&#44; 1 year&#44; 5 to 7 years&#44; and 10 to 12 years after surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "L&#46; Campeau"
                            1 => "M&#46; Enjalbert"
                            2 => "J&#46; Lesperance"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "1983"
                        "volumen" => "68"
                        "paginaInicial" => "II1"
                        "paginaFinal" => "II7"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6603280"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0735109706030257"
                          "estado" => "S300"
                          "issn" => "07351097"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "ACCF&#47;SCCT&#47;ACR&#47;AHA&#47;ASE&#47;ASNC&#47;NASCI&#47;SCAI&#47;SCMR 2010 appropriate use criteria for cardiac computed tomography&#46; A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force&#44; the Society of Cardiovascular Computed Tomography&#44; the American College of Radiology&#44; the American Heart Association&#44; the American Society of Echocardiography&#44; the American Society of Nuclear Cardiology&#44; the North American Society for Cardiovascular Imaging&#44; the Society for Cardiovascular Angiography and Interventions&#44; and the Society for Cardiovascular Magnetic Resonance"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46;J&#46; Taylor"
                            1 => "M&#46; Cerqueira"
                            2 => "J&#46;M&#46; Hodgson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIR.0b013e3181fcae66"
                      "Revista" => array:7 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2010"
                        "volumen" => "122"
                        "paginaInicial" => "e525"
                        "paginaFinal" => "e555"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20975004"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S073510971302929X"
                          "estado" => "S300"
                          "issn" => "07351097"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Improved noninvasive assessment of coronary artery bypass grafts with 64-slice computed tomographic angiography in an unselected patient population"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "T&#46;S&#46; Meyer"
                            1 => "S&#46; Martinoff"
                            2 => "M&#46; Hadamitzky"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2006.10.066"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2007"
                        "volumen" => "49"
                        "paginaInicial" => "946"
                        "paginaFinal" => "950"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17336717"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Non-invasive assessment of coronary artery bypass grafts by computed tomography&#58; comparison with conventional coronary angiography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46; Trigo Bautista"
                            1 => "J&#46; Estornell"
                            2 => "F&#46; Ridocci"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Esp Cardiol"
                        "fecha" => "2005"
                        "volumen" => "58"
                        "paginaInicial" => "807"
                        "paginaFinal" => "814"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16022812"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Does CT coronary angiography have a role in the evaluation of patients with CABG&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Albarjas"
                            1 => "K&#46; Alfakih"
                            2 => "J&#46; Hill"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Br J Cardiol"
                        "fecha" => "2012"
                        "volumen" => "19"
                        "paginaInicial" => "139"
                        "paginaFinal" => "140"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "To err is human&#58; building a safer health system"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Institute of Medicine &#40;US&#41; Committee on Quality of Health Care in America"
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46;T&#46; Kohn"
                            1 => "J&#46;M&#46; Corrigan"
                            2 => "M&#46;S&#46; Donaldson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2000"
                        "editorial" => "National Academies Press &#40;US&#41;"
                        "editorialLocalizacion" => "Washington &#40;DC&#41;"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/08702551/0000003600000009/v1_201709150927/S0870255117305607/v1_201709150927/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "29263"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Casos Cl&#237;nicos"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/08702551/0000003600000009/v1_201709150927/S0870255117305607/v1_201709150927/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117305607?idApp=UINPBA00004E"
]
Informação do artigo
ISSN: 08702551
Idioma original: Inglês
Dados atualizados diariamente
Ano/Mês Html Pdf Total
2024 Novembro 10 6 16
2024 Outubro 50 31 81
2024 Setembro 72 24 96
2024 Agosto 65 34 99
2024 Julho 46 34 80
2024 Junho 49 26 75
2024 Maio 42 16 58
2024 Abril 50 31 81
2024 Maro 43 18 61
2024 Fevereiro 44 21 65
2024 Janeiro 46 21 67
2023 Dezembro 47 21 68
2023 Novembro 50 33 83
2023 Outubro 20 13 33
2023 Setembro 41 23 64
2023 Agosto 37 16 53
2023 Julho 26 11 37
2023 Junho 36 13 49
2023 Maio 50 28 78
2023 Abril 29 4 33
2023 Maro 44 25 69
2023 Fevereiro 29 25 54
2023 Janeiro 27 13 40
2022 Dezembro 45 20 65
2022 Novembro 46 30 76
2022 Outubro 49 22 71
2022 Setembro 38 40 78
2022 Agosto 41 31 72
2022 Julho 36 40 76
2022 Junho 26 36 62
2022 Maio 37 40 77
2022 Abril 41 34 75
2022 Maro 30 34 64
2022 Fevereiro 27 33 60
2022 Janeiro 40 31 71
2021 Dezembro 38 23 61
2021 Novembro 42 39 81
2021 Outubro 47 49 96
2021 Setembro 39 27 66
2021 Agosto 34 30 64
2021 Julho 35 22 57
2021 Junho 30 19 49
2021 Maio 34 40 74
2021 Abril 52 41 93
2021 Maro 104 22 126
2021 Fevereiro 73 25 98
2021 Janeiro 51 14 65
2020 Dezembro 61 4 65
2020 Novembro 61 19 80
2020 Outubro 27 12 39
2020 Setembro 59 19 78
2020 Agosto 29 9 38
2020 Julho 45 10 55
2020 Junho 43 12 55
2020 Maio 62 5 67
2020 Abril 72 5 77
2020 Maro 139 13 152
2020 Fevereiro 226 13 239
2020 Janeiro 61 6 67
2019 Dezembro 46 8 54
2019 Novembro 45 8 53
2019 Outubro 21 10 31
2019 Setembro 40 8 48
2019 Agosto 54 8 62
2019 Julho 32 14 46
2019 Junho 51 14 65
2019 Maio 32 12 44
2019 Abril 26 14 40
2019 Maro 33 9 42
2019 Fevereiro 37 14 51
2019 Janeiro 67 8 75
2018 Dezembro 116 12 128
2018 Novembro 54 7 61
2018 Outubro 144 20 164
2018 Setembro 34 11 45
2018 Agosto 28 13 41
2018 Julho 21 5 26
2018 Junho 33 8 41
2018 Maio 37 7 44
2018 Abril 38 9 47
2018 Maro 44 17 61
2018 Fevereiro 33 14 47
2018 Janeiro 27 10 37
2017 Dezembro 40 20 60
2017 Novembro 48 16 64
2017 Outubro 48 41 89
2017 Setembro 46 28 74
2017 Agosto 4 9 13
Mostrar tudo

Siga este link para acessar o texto completo do artigo

Idiomas
Revista Portuguesa de Cardiologia
en pt

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos

Ao assinalar que é «Profissional de Saúde», declara conhecer e aceitar que a responsável pelo tratamento dos dados pessoais dos utilizadores da página de internet da Revista Portuguesa de Cardiologia (RPC), é esta entidade, com sede no Campo Grande, n.º 28, 13.º, 1700-093 Lisboa, com os telefones 217 970 685 e 217 817 630, fax 217 931 095 e com o endereço de correio eletrónico revista@spc.pt. Declaro para todos os fins, que assumo inteira responsabilidade pela veracidade e exatidão da afirmação aqui fornecida.