ABSTRACT
Coronary artery fistula is a rare congenital or acquired anomaly. It involves an abnormal connection between the coronary artery and the cardiac chambers or the large thoracic vessels. In some cases, the feeding coronary artery can become extremely dilated. The treatment includes a transcatheter or a surgical intervention depending on the complexity of the anomaly. We present the surgical treatment of the coronary artery to coronary sinus fistula, which includes the complete exclusion of the giant right coronary artery and followed by triple bypass surgery.
Subject(s)
Coronary Aneurysm/surgery , Coronary Sinus/abnormalities , Coronary Vessels/diagnostic imaging , Coronary Vessels/surgery , Vascular Fistula/complications , Vascular Surgical Procedures/methods , Coronary Aneurysm/diagnosis , Coronary Aneurysm/etiology , Coronary Angiography , Coronary Sinus/diagnostic imaging , Coronary Sinus/surgery , Humans , Male , Middle Aged , Tomography, X-Ray Computed , Vascular Fistula/diagnosis , Vascular Fistula/surgerySubject(s)
Calcinosis/diagnostic imaging , Calcinosis/surgery , Cardiac Surgical Procedures/methods , Cardiomyopathies/diagnostic imaging , Cardiomyopathies/surgery , Ventricular Outflow Obstruction/etiology , Ventricular Outflow Obstruction/surgery , Ventricular Septum , Calcinosis/complications , Cardiomyopathies/complications , Echocardiography , Female , Humans , Middle Aged , Multidetector Computed Tomography , Treatment Outcome , Ventricular Septum/diagnostic imaging , Ventricular Septum/surgerySubject(s)
Aneurysm/etiology , Arteriovenous Malformations/diagnostic imaging , Iliac Artery/abnormalities , Mesenteric Artery, Inferior/diagnostic imaging , Multidetector Computed Tomography , Aged , Aneurysm/diagnostic imaging , Arteriovenous Malformations/complications , Humans , Iliac Artery/diagnostic imaging , Male , Mesenteric Artery, Inferior/pathologyABSTRACT
BACKGROUND: Eagle syndrome represents elongated styloid process characterized by calcification and ossification of the stylohyoid ligament rarely associated with the pathology of carotid arteries. We are presenting a very rare case of bilateral Eagle syndrome with associated internal carotid artery (ICA) kinking on the right side and significant ICA stenosis on the left side. CASE REPORT: A 62-year-old female patient was admitted to our Institution for multidetector computed tomography (MDCT) angiography. Two years ago, she experienced stroke with right-sided weakness, color Doppler scan of carotid arteries described left ICA stenosis of 75% and right ICA stenosis of 50%. MDCT arteriography revealed bilateral Eagle syndrome associated with significant left ICA stenosis of >90% and right ICA kinking. Left carotid endarterectomy was performed followed by elongated styloid process resection that was in close relationship to ICA. Even more significant relationship was seen on the right side involving right ICA kinking and elongated styloid process that was treated conservatively. Postoperative course was uneventful; after 6 months, the patient was doing well. CONCLUSIONS: This is the first case that describes bilateral Eagle syndrome associated with ICA kinking on one side and significant stenosis on the other. Although rare, this syndrome should be thought of in symptomatic patients with carotid pathologies in which case computed tomography angiography is of crucial importance.
Subject(s)
Carotid Stenosis/etiology , Ossification, Heterotopic/complications , Temporal Bone/abnormalities , Carotid Artery, Internal/diagnostic imaging , Carotid Artery, Internal/surgery , Carotid Stenosis/diagnostic imaging , Carotid Stenosis/surgery , Computed Tomography Angiography , Endarterectomy, Carotid , Female , Humans , Middle Aged , Multidetector Computed Tomography , Ossification, Heterotopic/diagnosis , Ossification, Heterotopic/surgery , Severity of Illness Index , Temporal Bone/surgery , Treatment Outcome , Ultrasonography, Doppler, ColorABSTRACT
The pedicled left internal thoracic artery graft is the mandatory conduit in coronary artery bypass surgery. A grossly emphysematous lung may sometimes present a significant problem for positioning of the pedicled left internal thoracic artery conduit. An inverted pedicled left internal thoracic artery graft (internal thoracic artery transected near its origin, thus supplied by retrograde flow from superior epigastric and musculophrenic arteries) might occasionally be the conduit of choice for those patients.
Subject(s)
Coronary Occlusion/surgery , Internal Mammary-Coronary Artery Anastomosis/methods , Pulmonary Emphysema/complications , Aged , Coronary Angiography , Coronary Occlusion/complications , Coronary Occlusion/diagnosis , Humans , Male , Pulmonary Emphysema/diagnosis , Severity of Illness Index , Treatment OutcomeABSTRACT
The established superiority of the internal thoracic artery as a coronary arterial conduit has led to its mandatory use in coronary artery bypass grafting surgery. Therefore, the damage of the internal thoracic artery during harvesting is an abysmal complication, after which the conduit is usually discarded. An alternative approach is presented here, which has allowed us to use the distal two thirds of the proximally damaged left internal thoracic artery as an in situ (with retrograde blood supply from superior epigastric and musculophrenic arteries), reversed arterial conduit to revascularize the left anterior descending coronary artery.
Subject(s)
Internal Mammary-Coronary Artery Anastomosis/methods , Mammary Arteries/transplantation , Aged , Humans , MaleABSTRACT
INTRODUCTION: A right-sided aortic arch is a rare congenital defect of the aorta with incidence of 0.05% to 0.1% reported in published series. Usually it is associated with congenital heart anomalies and esophageal and tracheal compression symptoms. We present a case of a right-sided aortic arch of anomalous left subclavian artery origin, accidentally revealed during multislice CT (MSCT) supraaortic branches angiography. CASE OUTLINE: A 53-year-old female patient was examined at the Outpatients' Unit of the Vascular Surgery University Clinic for vertigo, occasional dizziness and difficulty with swallowing. Physical examination revealed a murmur of the left supraclavicular space, with 15 mmHg lower rate of arterial tension on the left arm. Ultrasound of carotid arteries revealed 60% stenosis of the left subclavian artery and bilateral internal carotid artery elongation. MSCT angiography revealed a right-sided aortic arch with aberrant separation of the left subclavian artery that was narrowed 50%, while internal carotid arteries were marginally elongated. There was no need for surgical treatment or percutaneous interventions, so that conservative treatment was indicated. CONCLUSION: A right-sided aortic arch is a very rare anomaly of the location and branching of the aorta. Multislice CT angiography is of great importance in the diagnostics of this rare disease.
