RESUMEN
Fístulas de artérias coronárias têm incidência baixa, sendo diagnosticadas mais frequentemente pelo ecocardiograma ou angiotomografia coronariana, embora a cineangiocoronariografia seja o método padrão-ouro. Têm origem mais comumente na artéria coronária direita, sendo a drenagem para câmaras de baixa pressão o mais habitual. O tratamento pode ser expectante, cirúrgico ou percutâneo. Este relato descreve o caso de uma rara apresentação de insuficiência cardíaca, dada por fístula da coronária circunflexa com drenagem para o átrio esquerdo. (AU)
Coronary artery fistulas have a low incidence and are often diagnosed by echocardiography or coronary computed tomography angiography, although coronary angiography is the gold standard. They commonly originate in the right coronary artery, with drainage to low-pressure chambers being the most frequent finding. Treatment can be expectant, surgical, or percutaneous. This report describes a case of a rare presentation of heart failure due to a fistula of the circumflex coronary artery with drainage into the left atrium. (AU)
Asunto(s)
Humanos , Masculino , Anciano , Fístula Arterio-Arterial/diagnóstico , Fístula Arterio-Arterial/etiología , Vasos Coronarios/patología , Atrios Cardíacos/anomalías , Insuficiencia Cardíaca/diagnóstico , Fibrilación Atrial/congénito , Cineangiografía/métodos , Ecocardiografía/métodos , Espectroscopía de Resonancia Magnética/uso terapéutico , Ecocardiografía Doppler , Fístula Arterio-Arterial/diagnóstico por imagen , Electrocardiografía/métodosAsunto(s)
Humanos , Masculino , Anciano , Arterias Bronquiales/diagnóstico por imagen , Fístula Arterio-Arterial/diagnóstico por imagen , Circulación Coronaria , Arterias Mamarias/diagnóstico por imagen , Arterias Bronquiales/cirugía , Fístula Arterio-Arterial/cirugía , Fístula Arterio-Arterial/etiología , Angiografía Coronaria/métodos , Angiografía por Tomografía Computarizada , Arterias Mamarias/cirugía , Revascularización Miocárdica/efectos adversosAsunto(s)
Humanos , Femenino , Adulto , Seno Coronario/patología , Arteria Coronaria Izquierda Anómala/patología , Arteria Coronaria Izquierda Anómala/diagnóstico por imagen , Hernia Umbilical/cirugía , Arteria Ilíaca/patología , Arteria Ilíaca/diagnóstico por imagen , Factores de Tiempo , Ecocardiografía/métodos , Cateterismo Cardíaco/métodos , Evolución Clínica/métodos , Fístula Arterio-Arterial/diagnóstico por imagen , Cuidados Posteriores , Angiografía por Resonancia Magnética/métodos , Ecocardiografía Doppler en Color/métodos , Electrocardiografía , Angiografía por Tomografía Computarizada/métodosRESUMEN
Abstract Coronary fistulas are rare anomalies that can affect approximately 1% of the population, presenting few specific symptoms, and are often found occasionally in coronary angiography. Here we describe the case of a 61-year-old patient with complaints of precordialgia and dyspnea since adolescence, with late diagnosis of coronary fistulas with drainage to the pulmonary artery, and with unsuccessful percutaneous treatment. Therefore, she underwent open surgery for the correction of the already known fistulas, in addition to the hemangioma involving such vessels, which made the understanding and resolution of this case more complex.
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Fístula Arterio-Arterial/cirugía , Fístula Arterio-Arterial/diagnóstico por imagen , Arteria Pulmonar/cirugía , Arteria Pulmonar/diagnóstico por imagen , Angiografía CoronariaRESUMEN
Abstract Aorto-atrial fistulas due to cardiac trauma are rare, and survivors require immediate surgical correction. Here, we report a case of an aorto-right atrial fistula due to penetrating trauma after a 16-year evolution, which developed symptoms of acute coronary syndrome and was treated with myocardial revascularization and correction of the aorto-cameral fistula.
Asunto(s)
Humanos , Masculino , Anciano , Enfermedades de la Aorta/diagnóstico por imagen , Fístula Arterio-Arterial/diagnóstico por imagen , Síndrome Coronario Agudo/diagnóstico por imagen , Enfermedades de la Aorta/cirugía , Enfermedades de la Aorta/etiología , Heridas Punzantes/complicaciones , Aortografía/métodos , Cineangiografía/métodos , Ecocardiografía/métodos , Fístula Arterio-Arterial/cirugía , Fístula Arterio-Arterial/etiología , Angiografía Coronaria/métodos , Electrocardiografía , Síndrome Coronario Agudo/cirugía , Síndrome Coronario Agudo/etiología , Atrios Cardíacos/lesiones , Atrios Cardíacos/diagnóstico por imagenAsunto(s)
Humanos , Femenino , Persona de Mediana Edad , Enfermedad de la Arteria Coronaria/terapia , Fístula Arterio-Arterial/terapia , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Estudios de Seguimiento , Fístula Arterio-Arterial/diagnóstico por imagen , Angiografía Coronaria/métodos , Enfermedades AsintomáticasAsunto(s)
Humanos , Niño , Adolescente , Cateterismo Cardíaco/métodos , Fístula Arterio-Arterial/cirugía , Anomalías de los Vasos Coronarios/cirugía , Ventrículos Cardíacos/anomalías , Ventrículos Cardíacos/cirugía , Aneurisma Coronario/cirugía , Cineangiografía/métodos , Fístula Arterio-Arterial/diagnóstico por imagen , Resultado del Tratamiento , Anomalías de los Vasos Coronarios/diagnóstico por imagen , Ventrículos Cardíacos/diagnóstico por imagenRESUMEN
Abstract Objective: The aim of this study was to describe the demographic, clinical and anatomic characteristics of coronary arteriovenous fistulas in adult patients who underwent open cardiac surgery and to review surgical management and outcomes. Methods: Twenty-one adult patients (12 female, 9 male; mean age: 56.1±7.9 years) who underwent surgical treatment for coronary arteriovenous fistulas were retrospectively included in this study. Coronary angiography, chest X-ray, electrocardiography and transthoracic echocardiography were preoperatively performed in all patients. Demographic and clinical data were also collected. Postoperative courses of all patients were monitored and postoperative complications were noted. Results: A total of 25 coronary arteriovenous fistulas were detected in 21 patients; the fistulas originated mainly from left anterior descending artery (n=9, 42.8%). Four (19.4%) patients had bilateral fistulas originating from both left anterior descending and right coronary artery. The main drainage site of coronary arteriovenous fistulas was the pulmonary artery (n=18, 85.7%). Twelve (57.1%) patients had isolated coronary arteriovenous fistulas and 4 (19.4%), concomitant coronary artery disease. Twenty (95.3%) of all patients were symptomatic. Seventeen patients were operated on with and 4 without cardiopulmonary bypass. There was no mortality. Three patients had postoperative atrial fibrillation. One patient had pericardial effusion causing cardiac tamponade who underwent reoperation. Conclusion: The decision of surgical management should be made on the size and the anatomical location of coronary arteriovenous fistulas and concomitant cardiac comorbidities. Surgical closure with ligation of coronary arteriovenous fistulas can be performed easily with on-pump or off-pump coronary artery bypass grafting, even in asymptomatic patients to prevent fistula related complications with very low risk of mortality and morbidity.