Correção de fístula coronariana sem circulação extracorpórea: técnica da sutura única / Off-pump correction of coronary fistula: the single suture technique approach

A técnica da sutura única foi desenvolvida para obter estabilização e exposição de todos os ramos coronarianos durante a cirurgia de revascularização do miocárdio, mantendo a estabilidade hemodinâmica durante o procedimento. Nós descrevemos a utilização desta técnica durante a correção de uma fístula arterial coronariana associada à dilatação coronariana direita, sem a utilização da circulação extracorpórea. A técnica sugerida é mais rápida e menos complexa do que a utilização do desvio cardiopulmonar. Além disso, essa técnica pode ser uma ferramenta útil para a correção de fístulas arteriais coronarianas em casos selecionados, permitindo a prática de abordagens menos invasivas nesses pacientes.

The single suture technique was developed to obtain stabilization and exposure of all all coronary branches during off-pump coronary artery bypass, while maintaining hemodynamic stabilily during the procedure. We describe the use of this technique during an off-pump correction of a coronary artery fistula associated with right coronary dilatation. The suggested technique is quicker and less complex than on-pump surgery. Furthermore, it can be a useful tool for congenital fistula correction in select cases, stimulating the practice of less invasive heart surgery in these patients.

Embolization of congenital intrahepatic porto-systemic shunt by n-butyl cyanoacrylate.

Congenital intrahepatic portosystemic venous shunt (IHPSVS) is rare vascular anomaly. We present one case of a 14- month male child who presented with global developmental delay. Child had high ammonia levels with low glutamine and high bile salts on the previous investigations and had history of neonatal seizures since day 13 of life. On admission, serum ammonia levels were elevated to 112μmol/L. Other laboratory investigations including liver and renal function test, and electrolytes were normal. He was, diagnosed to have IHPSVS on the basis of Doppler and CT, and treated by embolization with n-butyl cyanoacrylate (glue). A brief review of diagnostic modalities and endovascular management for the IHPSVS is presented including the present case.

Fistula coronaria congénita: presentación de siete casos y revisión de la literatura / Congenital coronary fistula: clinical presentation in 7 cases and literature review

Congenital coronary artery fistulas are uncommon anomalies, however themselves may resemble the whole spectrum of cardiac manifestations. Clinical presentations vary considerably from adults to children. MATERIAL AND METHODS: patients with coronary artery fistula diagnosed by selective coronariography in the period from 2000 to 2007 were included. RESULTS: 7 cases were found, 4 children, mean age 6.5 years, and 3 adults, mean age 25.6 years. The fistulae originate from the left coronary artery in 3 children, 2 connect to the pulmonary artery an one to the right atrium, in one child the fistula originated from the right coronary artery and terminated at the right ventricle. In the 3 adult patients, the fistula originated from the right ventricle, two connected to the right ventricle and one to the coronary sinus. Two children were operated on successfully and are asymptomatic 1 and 4 years later. In an adult patient with surgical ligation was performed, 4 weeks later developed an uncomplicated myocardial infarction. We reviewed the literature available and were compared with our cases. CONCLUSIONS: The clinical manifestations and hemodynamic features differ in childhood and adulthood. Coronary angiography is the primary diagnostic tool. Surgical treatment has low mortality and morbidity.

Congenital intrahepatic portosystemic shunt--an incidental rare anomaly.

Congenital intrahepatic shunts are rare anomalies that are usually incidental in a child who undergoes an ultrasound examination for some other reasons. Early diagnosis is important, because the condition can lead to hepatic encephalopathy and hypoglycemia. Author's would like to describe the findings of one such patient diagnosed to be having congenital intrahepatic shunt and discuss the clinical importance of this condition.

Múltiplas fístulas das artérias coronárias ao ventrículo esquerdo / Multiple Coronary Artery to Left Ventricle Fistulae

A 51 year-old man was admitted to the coronary care unit due an episode of retroestenal pain with ischaemic alterations in electrocardiogram. It was made the diagnosis of unstable angina. Cinecoronariography showed dilated coronary arteries without obstructions and multiples coronary fistulas draining into left ventricular cavity. Transesophagic echocardiogram with microbubbles injection into coronary arteries showed an important coronary steal phenomena. It is discussed the diagnosis and the treatment. This is one of the rare cases of coronary fistulas draining into the left ventricular cavity and the first one with alterations in the rest ECG.

Coronary artery-intramyocardial sinusoid communication in a case of pulmonary atresia with intact ventricular septum.

Intramyocardial sinusoid--coronary artery fistulous communications are well established channels in pulmonary atresia with intact ventricular septum. Angiographically flow can be demonstrated from the right ventricular cavity into the coronary arteries. We have histologically demonstrated such a communication in a case of pulmonary atresia with intact septum.