RESUMO
BACKGROUND: The relatively high mortality in patients with pulmonary atresia and intact ventricular septum may be related to the presence of significant coronary arterial anomalies. This retrospective review of cineangiocardiograms was undertaken to further elucidate the types and variety of such coronary arterial abnormalities, and to assess their effect on postoperative survival. MATERIAL AND RESULTS: Details regarding coronary arterial anatomy and abnormalities were assessed in 116 patients. We noted the site and severity of lesions, and the presence of fistulous communications from the right ventricle to the coronary arteries, assessing the proportion of left ventricular myocardium affected by coronary arterial interruptions or significant stenoses, in other words, the amount dependent on coronary circulation from the right ventricle. We also measured diameters of the tricuspid and mitral valves. Fistulas were found in 87 patients (75%), interruptions of major coronary arteries in 40 patients (34%), lack of connections between the coronary arteries and the aorta in 18 patients (16%), and single origin of a coronary artery, with the right coronary artery arising from the left, in 6 patients (5%). We found increased mortality in 47 patients (40%) who had a right ventricular-dependent coronary arterial circulation. The presence of fistulas in itself was not associated with higher mortality, but the presence of coronary arterial interruptions (p = 0.05), and a higher myocardial score (p = 0.0009), were. CONCLUSION: We encountered a higher prevalence of both coronary arterial abnormalities and right ventricular-dependent circulation than previously reported. Awareness of the severity of the coronary arterial abnormalities should assist in planning treatment.
Assuntos
Anomalias dos Vasos Coronários/epidemiologia , Atresia Pulmonar/complicações , Atresia Pulmonar/mortalidade , Anomalias dos Vasos Coronários/cirurgia , Feminino , Humanos , Recém-Nascido , Masculino , Prevalência , Atresia Pulmonar/cirurgia , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Taxa de Sobrevida , Resultado do TratamentoRESUMO
Congenital arteriovenous fistulas between the thoracic arteries and the systemic veins are rare, and in clinical terms may mimic patency of the arterial duct. We present a neonate with a large arteriovenous fistula between the left sixth intercostal artery and the left brachiocephalic vein, to the best of our knowledge a unique site of drainage. To our knowledge, ours is also the earliest presentation and treatment of a thoracic arteriovenous fistula.
