RESUMO
A rare case of myocardial infarction secondary to multiple coronary artery fistulae is described. Coronary angiography showed the fistulae originating from the distal septal branch of the left anterior descending artery and distal branches of the right coronary and circumflex arteries, and drained into the left ventricle. A myocardial perfusion scan showed a fixed perfusion defect.
Assuntos
Angiografia Coronária , Anomalias dos Vasos Coronários/complicações , Vasos Coronários/patologia , Ventrículos do Coração/patologia , Infarto do Miocárdio/etiologia , Fístula Vascular/complicações , Anomalias dos Vasos Coronários/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Ventrículos do Coração/diagnóstico por imagem , Humanos , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico por imagem , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/patologiaRESUMO
Many complications have been reported after cardiopulmonary bypass. A common physiologic change during the early postoperative period after cardiopulmonary bypass is increased diuresis. In patients whose urine output is increased, postoperative diabetes insipidus can develop, although reports of this are rare. We present the cases of 2 patients who underwent on-pump coronary artery bypass grafting (with cardiopulmonary bypass). Each was diagnosed with diabetes insipidus postoperatively: a 54-year-old man on the 3rd day, and a 66-year-old man on the 4th day. Each patient recovered from the condition after 6 hours of intranasal therapy with synthetic vasopressin (antidiuretic hormone). The diagnosis of diabetes insipidus should be considered in patients who produce excessive urine early after cardiac surgery in which cardiopulmonary bypass has been used.
Assuntos
Ponte Cardiopulmonar/efeitos adversos , Ponte de Artéria Coronária/efeitos adversos , Diabetes Insípido/etiologia , Administração Intranasal , Idoso , Antidiuréticos/administração & dosagem , Desamino Arginina Vasopressina/administração & dosagem , Diabetes Insípido/diagnóstico , Diabetes Insípido/tratamento farmacológico , Diabetes Insípido/fisiopatologia , Esquema de Medicação , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento , MicçãoRESUMO
A 17-year-old girl with neurofibromatosis type 1 presented with unstable angina. Cardiac catheterization revealed an aneurysm with thrombus in the left anterior descending coronary artery. She was discharged on medical treatment but returned 2 months later with severe chest pains. Angiography revealed an increase in the size of the aneurysm in the left anterior descending coronary artery, with thrombus and dissection. The patient underwent coronary artery bypass surgery. Follow-up after 1 year revealed no problems.
