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Embolic renal infarct, patent foramen ovale and coronary artery dissection: a strange case of cardio-renal connection.
MedLine Citation:
PMID:  21241977     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
A 50-year-old female with no cardiovascular risk factors presented to our service for urgent coronary angiography because of an acute coronary syndrome with electrocardiographic inferior ST elevation. The coronary angiography revealed the occlusion of a small distal branch of the posterior interventricular artery in the total absence of even mild coronary atherosclerosis with a concomitant regional akinesia of the distal inferior left ventricular wall. The patient was referred to medical therapy with double antiplatelet therapy with aspirin and clopidogrel. The patient being still hypertensive despite therapy with nitrates and symptomatic for angina, a computed tomographic scan was performed, revealing no aortic dissection but a small right cortical renal infarct. A rise in creatinine greater than 25% (0.3 mg/dl) from baseline documented a condition of acute kidney injury class "R." Two days after, on control coronary angiography the branch of the posterior interventricular coronary appeared as a dissection of a branch of moderate calibre. The echocardiogram confirmed a distal inferior left ventricular wall akinesia with a preserved left ventricular ejection fraction, but more interestingly, revealed a patent foramen ovale (PFO) with massive right to left shunt after Valsalva manoeuvre and a moderate atrial septal aneurysm. Based on reported findings we hypothesized that a paradoxical embolism trough the PFO caused the renal infarct and a subsequent high blood pressure-induced coronary artery dissection.
Authors:
Federico Ronco; Gianluca Rigatelli; Fabio Dell'avvocata; Massimo Giordan; Claudio Ronco; Paolo Cardaioli
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Publication Detail:
Type:  Journal Article     Date:  2010-10-20
Journal Detail:
Title:  Cardiovascular revascularization medicine : including molecular interventions     Volume:  12     ISSN:  1878-0938     ISO Abbreviation:  Cardiovasc Revasc Med     Publication Date:    2011 Jan-Mar
Date Detail:
Created Date:  2011-01-18     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101238551     Medline TA:  Cardiovasc Revasc Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  67.e5-7     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Elsevier Inc. All rights reserved.
Affiliation:
Cardiovascular Diagnosis and Endoluminal Interventions Unit, Rovigo General Hospital, Rovigo, Italy.
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