ABSTRACT
A coronary fistula is defined as a direct connection between a coronary artery and a heart chamber, great vessel, or other vascular structure that "bypasses" the myocardial capillary bed. This is a rare pathology that is usually not discovered until later in life, and exceptionally not during childhood. We report the case of a young patient who was hospitalized for chest pain and shortness of breath and who was found to have a coronary fistula on angiography. A 66-year-old patient. Hypertension on dual therapy for 16 years and diabetes on OAD (Oral Antidiabetic) for 4 years. He was hospitalized with typical angina pectoris and dyspnea, and the stress test was positive. Laboratory examination revealed a good general condition with NYHA stage 3 dyspneic angina pectoris extending to the upper extremities and no evidence of heart failure. Looking at the balance, we see a slight increase in troponin. ECG returns to regular sinus rhythm, with electrical LVH (left ventricular hypertrophy) and ambient negative waves, no rhythm or conduction abnormalities. Transthoracic echocardiography (TTE) reverses hypertensive heart disease with good global and partial contractility without significant valvular disease associated with systolic pulmonary arterial pressure (SPAP) at 35 mmHg. Coronary angiography is performed and shows evidence of minor involvement of the central CX artery and a coronary camera fistula from the first diagonal artery draining into the left ventricle. Management was about optimizing medical care. The patient received an appointment and was declared discharged. Coronary camera fistulae are rare, found in approximately 0.3% of coronary angiographic studies performed. Most are congenital and may occur primarily due to trauma, erosive infection of the vessel wall, or iatrogenicity during transluminal coronary angioplasty, myocardial biopsy, or valve replacement. In many cases, simple but complex forms can be described. The gold standard for confirming the diagnosis remains coronary angiography, which highlights both the affected arteries and drainage sites. Cardiac scanners occupy an increasingly important position, especially as they provide morphologically accurate information. Surgical or percutaneous treatment of the fistula with a coil is recommended in symptomatic adult patients, especially those with significant or complicated right-to-left shunts. The authors suggest treatment with ?-blockers when multiple sinusoidal fistulas associated with ventricular wall hypertrophy are present. Close monitoring is recommended for asymptomatic small fistula. Corneal fistula is a rare congenital or acquired condition that is mostly asymptomatic and discovered in adulthood. Coronary angiography and heart scan can be used to confirm the diagnosis. Treatment is usually surgical or endovascular. However, in some cases, drug treatment with beta-blockers may help.
ABSTRACT
Pacemaker infective endocarditis is a more real diagnostic problem than a therapeutic one. The precise impact is not well known. Its incidence is poorly known, and it is a serious infection with an estimated mortality of around 25%. It is with this in mind that we report 2 clinical cases with a literature review. Case 1: An 88-year-old patient with a double chamber pacemaker was admitted for febrile syndrome with a fever at 39.2°. Transthoracic and transesophageal echocardiography (TOE) found an image of vegetation on the aortic valve measuring 9mm, located on the noncoronary cusp, and overflowing on the right coronary cusp. An inflammatory syndrome was found on blood tests. Blood culture, wound swab culture, and bacteriological study of material after removal revealed Staphylococcus Aureus Meti S. The patient was initially put on Vancomycin with a loading dose of 2g / 24h then 1g / 24h, and the pacemaker was extracted. Case 2: A 68-year-old with a double chamber pacemaker (PM) was admitted for fever at 39 ° c with suppuration of the PM pocket. Echocardiography identified an image on the tricuspid valve measuring 14x8 mm evoking vegetation given the context. Two blood cultures and swabs isolated a Staphylococcus aureus. The patient was administered Triaxon 2g / day for 4 weeks and gentamycin 180 mg for 15 days. The pacemaker was removed. Pacemaker Infective endocarditis is rare, poorly understood, very serious, and potentially fatal, accounting for up to about 7% in some case series. In half of the cases, they affect the endocavitary leads, but also the valves, and in 45% of cases the infection of the pocket. The average age is 65 years. The clinical symptoms are disparate making the diagnosis more difficult, it must be evoked in case of unexplained fever in a patient implanted with a Pacemaker. Bactericidal dual therapy should be administered after blood cultures in case of strong suspicion of infective endocarditis (IE) and adapted after identification of the germ in question. Most authors are adamant about extracting any pacemaker whenever possible.