ABSTRACT
Coronary–cameral fistulas (CCFs) are mostly congenital in origin and rarely acquired. Clinical symptoms are decided by the hemodynamic significance of the coronary fistula. Even in asymptomatic patients, it is essential to know about coronary CCF particularly if the patient is to undergo cardiac surgery with cardioplegic cardiac arrest. Incidental finding of coronary CCF should never be ignored. Intraoperative myocardial protection and methods used are significantly influenced by such fistula.
ABSTRACT
Resumen: Las fístulas coronarias son una comunicación anómala directa entre las arterias coronarias y las cavidades cardíacas o alguno de los vasos sanguíneos próximos al corazón. Son poco comunes, con una incidencia angiográfica entre 0,1%-2%. Dependiendo de la magnitud de robo coronario, pueden ser asintomáticas o causar cuadros clínicos graves con alta repercusión funcional, como isquemia miocárdica, insuficiencia cardíaca congestiva, endocarditis, infecciones recurrentes del aparato respiratorio o en casos raros hipertensión pulmonar. Se presenta el caso de una paciente con fístulas coronarias que ocasionaron isquemia miocárdica por robo de flujo coronario con importante repercusión clínica y hemodinámica. El diagnóstico definitivo se llevó a cabo mediante intervencionismo coronario percutáneo y dadas las características anatómicas de las fístulas, se determinó tratamiento médico.
Summary: Coronary fistulas are an anomalous direct communication between the coronary arteries and one of the four cardiac cavities or one of the blood vessels near the heart, are uncommon with an angiographic incidence between 0.1% - 2%, and, depending of the magnitude of coronary steal, they may be asymptomatic or cause severe clinical symptoms with high functional repercussion, such as myocardial ischemia, congestive heart failure, endocarditis, recurrent respiratory infections or, in rare cases, pulmonary hypertension. We present a case of a female patient with coronary fistulas that caused myocardial ischemia due to coronary flow steal with important clinical and hemodynamic repercussions. The definitive diagnosis was made through percutaneous coronary intervention and given the anatomical characteristics of the fistulas, medical treatment was determined.
Resumo: As fístulas coronarianas são uma comunicação anômala direta entre as artérias coronárias e uma das quatro cavidades cardíacas ou um dos vasos sanguíneos próximos ao coração; são incomuns com uma incidência angiográfica entre 0,1% - 2% e, dependendo da magnitude do roubo coronariano, podem ser assintomáticos ou causar sintomas clínicos graves, com alta repercussão funcional, como isquemia miocárdica, insuficiência cardíaca congestiva, endocardite, infecções respiratórias de repetição ou, em raros casos, hipertensão pulmonar. Apresentamos um caso de uma paciente com fístulas coronarianas que causaram isquemia miocárdica por roubo de fluxo coronariano com importante repercussão clínica e hemodinâmica. O diagnóstico definitivo foi feito por meio de intervenção coronariana percutânea e, dadas as características anatômicas das fístulas, foi determinado tratamento médico.
ABSTRACT
La parada cardiaca en su mayoría es secundaria a enfermedad coronaria, este artículo hace referencia a un paciente con una paro cardiaco secundario a un infarto agudo del miocardio con elevación del ST que se estudió documentando arterias epicárdicas sanas, pero con la presencia de una fístula entre la arteria descendente anterior hacia una lesión neoplásica de mediastino que previamente se había documentado en estudios imagenológicos anteriores. Las fístulas coronarias son raras en su presentación, este caso demuestra una fístula asociada a la presencia de un tumor del mediastino que se presenta al servicio de urgencias en parada cardiaca, una causa bizarra en la determinación de la etiología del paro. (Acta Med Colomb 2016; 41: 71-73).
Cardiac arrest is mostly secondary to coronary disease; this article refers to a patient with cardiac arrest secondary to acute myocardial infarction with ST elevation who was studied documenting healthy epicardial arteries, but with the presence of a fistula between the left anterior descending artery into a neoplastic lesion of the mediastinum that was documented in previous imaging studies. Coronary fistulae are rare in its presentation; this case demonstrates a fistula associated with the presence of a tumor of the mediastinum of a patient admitted in the emergency department in cardiac arrest being a bizarre cause in determining the etiology of cardiac arrest. (Acta Med Colomb 2016; 41: 71-73).
Subject(s)
Humans , Male , Middle Aged , Heart Arrest , Coronary Disease , Fistula , ST Elevation Myocardial Infarction , MediastinumABSTRACT
<p>Congenital coronary artery-pulmonary artery fistula is rare and occurs concomitantly with various disease conditions, including myocardial ischemia symptoms and aneurisms. Such a fistula complicated by continuity to a systemic blood vessel is even rarer. The patient was a healthy 75-year-old man who had lost consciousness for several tens of seconds at home. An examination performed at a nearby neurosurgical clinic showed no abnormalities, and he was referred to our cardiovascular department for detailed examination for suspected cardiogenic syncope. Sick sinus syndrome was diagnosed based on Holter monitoring. Pulmonary artery-bilateral coronary artery fistula with coronary artery stenosis was diagnosed on coronary arteriography. It was difficult to determine whether coronary bypass surgery was indicated because of the presence of a fistula. Based on the overall evaluation of coronary fractional flow reserve, coronary artery ultrasound, and stress myocardial scintigraphy in addition to usual coronary arteriography, triple-vessel bypass surgery was indicated. Preoperative CT angiography showed a left common carotid artery/bronchial artery-pulmonary artery fistula, with a communication at a bilateral coronary artery-pulmonary artery fistula. Coronary artery bypass surgery was performed in addition to coronary artery-pulmonary artery fistula ligation, left common carotid artery-pulmonary artery fistula closure, bronchial artery-pulmonary artery fistula closure, and pacemaker implantation. Preoperative CT angiography and perioperative surface echocardiography were useful for locating fistula openings. The abnormal blood vessels that allowed blood flow from the left common carotid and bronchial arteries, and into the fistula vessel opening were ligated previously. When cardioplegic solution was injected, the fistula opening was directly pressed, which facilitated the solution to spread over the cardiac muscle, contributing to full cardiac arrest. Postoperative CT angiography showed disappearance of the pulmonary artery-bilateral coronary artery fistula and left common carotid artery/bronchial artery-pulmonary artery fistula. To our knowledge, there are no reports describing the surgical treatment of left common carotid artery/bronchial artery-pulmonary artery fistula and bilateral coronary artery-pulmonary artery fistula. Here we report this rare case with a review of the relevant literature.</p>
ABSTRACT
Relatamos o caso de um paciente do sexo feminino, assintomática, com grande fístula bilateral da artéria coronária-artéria pulmonar. O monitoramento clínico foi a opção escolhida para tratamento. Discutimos os pormenores das opções terapêuticas, enfatizando a tendência excessiva de utilizar a abordagem cirúrgica e a grande escassez de acompanhamentos clínicos de longo prazo em pacientes assintomáticos.
We report the case of an asymptomatic female patient, with a large non-complicated bilateral coronary-pulmonary artery fistula. Clinical monitoring was the choice of treatment. We discuss the therapeutic options in depth, emphasizing the excessive tendency of the surgical approach and the great scarcity of reports on long-term clinical follow-up in asymptomatic patients.
Relatamos el caso de un paciente del sexo femenino, asintomática, con gran fístula bilateral de la arteria coronaria-arteria pulmonar. El monitoreo clínico fue la opción elegida para el tratamiento. Discutimos los pormenores de las opciones terapéuticas, enfatizando la tendencia excesiva de utilizar el abordaje quirúrgico y la gran escasez de seguimientos clínicos de largo plazo en pacientes asintomáticos.
Subject(s)
Female , Humans , Middle Aged , Arterio-Arterial Fistula/therapy , Coronary Disease/therapy , Arterio-Arterial Fistula/diagnosis , Coronary Disease/diagnosis , Monitoring, Physiologic , Pulmonary Artery , Pulmonary ArteryABSTRACT
Background: Diagnosis of coronary fistula is quite challenging, requires the combination of clinical experience, echocardiography and catheterization. Objective: The study is to evaluate the role of cardiac Doppler color ultrasound for diagnosis of coronary fistula. Subjects and method: Results from both cardiac Doppler color ultrasound and catheterization with a hemodynamic study of 17 patients were compared to estimate sensitivity and specificity. Results: Echocardiography can correctly diagnose coronary fistula, compared with cardiac catheterization (both sensitivity and specificity are 100%). It can also assess the presence of fistula (sensitivity 82.2%) and degree of fistula dilatation (sensitivity 94%, specificity 100%). Conclusion: Cardiac Doppler color ultrasound is a good non-invasive method to diagnose coronary fistula, to evaluate the morphology, location and level of the fistula.
Subject(s)
Coronary Artery Disease , EchocardiographyABSTRACT
We report a case of coronary fistula between the left anterior descending and main pulmonary artery complicating acute non-Q wave myocardial infarction. A 27-year-old man visited emergency department because of severe chest pain lasting two hours. The electrocardiogram showed ST segment elevation in precordial leads V3~6. Cardiac enzymes were as follows;CK-MB:36.44 IU/L T-T:0.489 ng/mL, CPK:542 IU/L, and LDH:475 IU/L. The thallium-201 dipyridamole stress perfusion scan showed perfusion defect and reversed redistribution in the anteroseptal wall. The coronary angiogram revealed coronary artery fistula between the proximal left anterior descending artery and main pulmonary artery without significant stenoses of coronary arteries. The result of ergonovine test was negative. After micro-coil embolization to the coronary fistula, symptoms were improved. Follow-up thallium-201 scan showed normalized blood flow in the left anteroseptal wall.
Subject(s)
Adult , Humans , Arteries , Chest Pain , Constriction, Pathologic , Coronary Vessels , Dipyridamole , Electrocardiography , Emergency Service, Hospital , Ergonovine , Fistula , Follow-Up Studies , Myocardial Infarction , Perfusion , Pulmonary ArteryABSTRACT
Congenital left ventricular aneurysm is rare, poorly understood, and potentially lethal. Also, congenital coronary artery fistula is rare but hemodynamically, it induces myocardial ischemia due to coronary steal syndrome and diastolic volume overload from a left to left shunt. A 64-year-old women with abnormal ECG and mild exertional dyspnea was admitted to our hospital for further evaluation. Electrocardiography demonstrated Q waves, inverted T waves in the inferior leads and right bundle brach block. Transthoracic electrocardiography showed left ventricular septal aneurysm. Cardiac catheterization, a selective left coronary arteriogram revealed a fistula. The fistula originated from the proximal portion of the left anterior descending coronary artery and drained into the left ventricle. Magnetic resonance imaging demonstrated congenital defect muscular portion of interventricular septum. Thallium 201 heart spect showed regional perfusion defect along the inferior-lateral segment of the left ventricle. Then we report an congenital left ventricular septal aneurysm associated with coronary fistula.
Subject(s)
Female , Humans , Middle Aged , Aneurysm , Cardiac Catheterization , Cardiac Catheters , Congenital Abnormalities , Coronary Vessels , Dyspnea , Electrocardiography , Fistula , Heart , Heart Ventricles , Magnetic Resonance Imaging , Myocardial Ischemia , Perfusion , Thallium , Tomography, Emission-Computed, Single-PhotonABSTRACT
Congenital left ventricular aneurysm is rare, poorly understood, and potentially lethal. Also, congenital coronary artery fistula is rare but hemodynamically, it induces myocardial ischemia due to coronary steal syndrome and diastolic volume overload from a left to left shunt. A 64-year-old women with abnormal ECG and mild exertional dyspnea was admitted to our hospital for further evaluation. Electrocardiography demonstrated Q waves, inverted T waves in the inferior leads and right bundle brach block. Transthoracic electrocardiography showed left ventricular septal aneurysm. Cardiac catheterization, a selective left coronary arteriogram revealed a fistula. The fistula originated from the proximal portion of the left anterior descending coronary artery and drained into the left ventricle. Magnetic resonance imaging demonstrated congenital defect muscular portion of interventricular septum. Thallium 201 heart spect showed regional perfusion defect along the inferior-lateral segment of the left ventricle. Then we report an congenital left ventricular septal aneurysm associated with coronary fistula.