RESUMO
A 55 year-old man with huge coronary artery fistula to the right atrium is presented. The Qp/Qs ratio was 1.6. We failed to place simultaneously three interlocking detachable coils for closing the fistula, because the coils were washed out into the right atrium. We deployed the coronary stent at the distal portion of the coronary artery. This procedure enabled us to anchor 7 electrically or interlocking detachable coils and to interrupt the shunt flow. A Doppler flow wire was useful to reveal instantaneously the extent of flow reduction even when contrast angiography was not performed in each procedure.
Assuntos
Fístula Artério-Arterial/terapia , Embolização Terapêutica/métodos , Stents , Fístula Artério-Arterial/diagnóstico por imagem , Fístula Artério-Arterial/fisiopatologia , Velocidade do Fluxo Sanguíneo , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/fisiopatologia , Vasos Coronários/cirurgia , Ecocardiografia Transesofagiana , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/fisiopatologia , Átrios do Coração/cirurgia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: We sought to investigate whether left atrial (LA) appendage (LAA) function was impaired in patients with systemic embolism in sinus rhythm. METHODS: Transesophageal echocardiography was performed in 7 patients within 5 days after embolism (early group) and in 32 patients, more than 5 days after embolism (late group). We searched intracardiac thrombus and determined LAA area and LAA flow velocity, and the grade of spontaneous echocontrast. RESULTS: LA thrombus could be detected in 2 of the 39 patients only in early group (P = .028). The patients of early group, as compared with late group, had lower LAA flow velocity (28 +/- 16 vs 60 +/- 26 cm/s, P = .007) and higher grade of spontaneous echocontrast score (1.14 +/- 1.46 vs 0.25 +/- 0.62, P = .013). LA dimension and LAA area were not statistically different. CONCLUSION: LAA function may be impaired early after embolism even in sinus rhythm.
