Congenital coronary artery-left ventricular multiple micro-fistulas and hypertrophic cardiomyopathy: a case report and literature review.

BACKGROUND: Coronary artery-left ventricular multiple micro-fistulas (CA-LVMMFs) is a rare congenital vascular anomaly that may present with no obvious clinical symptoms or a typical angina attack. CA-LVMMFs is usually found unexpectedly during coronary angiography (CAG). CASE PRESENTATION: We report a case of a 65-year-old man admitted to the hospital with acute coronary syndrome. CA-LVMMFs was found during coronary angiography. Echocardiography showed apical hypertrophy and blood flow signals were seen in the apical myocardium, connected with the left ventricle. We searched the MEDLINE database and found 39 relevant reports. We made statistics on the clinical characteristics of these patients and found half involved hypertrophy or perfusion defects in the ventricular septum or apex. CONCLUSION: As a rare congenital anomaly, the effect of CA-LVMMFs on patients is unclear. By reporting a case and summarizing literature reports, we found that CA-LVMMFs may be associated with myocardial hypertrophy, especially ventricular septal and apical hypertrophy.

Coronary-cameral fistulas in adults (first of two parts).

This is a case series and review of the literature adding 11 new cases. Coronary-cameral fistulas (CCFs) are infrequent anomalies which are in general co-incidentally found during diagnostic coronary angiography (CAG). To delineate the characteristics of congenital and acquired CCFs in adults, we performed a PubMed search for papers dealing with congenital or acquired CCFs in adults. Publications on coronary-vascular fistulas or paediatric subjects were not included. From the world literature, a total of 243 adult patients were identified who had congenital (65%) or acquired (35%) CCFs. In this review, which is part one of a two-part series on CCFs, we describe and discuss the congenital fistulas, give an overview on the published literature and report details of our own series of 11 patients with MMFs and solitary macro CCFs. Of the congenital group, 85% were small or large solitary macro CCFs (cut-off 1.5 mm) and 15% were coronary artery-ventricular multiple micro-fistulas (MMFs). Apical hypertrophic cardiomyopathy was reported in some of the reviewed subjects with MMFs (3/24 = 13%) but not was seen in our own series. Conservative medical management was generally the treatment of choice in congenital MMFs; prophylactic implantable cardioverter defibrillators (ICD) were implanted in 2/24 (8%) of subjects, especially when extensive micro-fistulisations were involved. None of the patients of our own series required an ICD, as the MMFs were of limited size. Congenital or acquired CCFs in adults are infrequent anomalies having a wide spectrum of clinical presentation may varies from asymptomatic to severely devastating states requiring different treatment modalities.

Cirugía de la fístula arteriovenosa de la mano / Surgery of the arteriovenous fistula of the hand

Una fístula arteriovenosa es la comunicación anormal entre una arteria y una vena, con el retorno de la sangre a las cavidades cardíacas sin pasar a través del lecho capilar. El propósito de este trabajo es describir las características de la fístula arteriovenosa de la mano. Se estudiaron dos pacientes ingresados en el Servicio de Arteriología del Instituto Nacional de Angiología y Cirugía Vascular en el año 2012 con antecedentes de esta enfermedad. Al examen físico, se confirmó la presencia de una tumoración de forma redondeada en la palma de la mano. El diagnóstico confirmatorio de fístula arteriovenosa se realizó por ecodoppler color, angioTAC e intervención quirúrgica. Este último proceder se inició, en ambos casos, con el abordaje de la arteria humeral por encima de la flexura del codo para controlar, si se produjera, algún sangrado distal de la arteria ulnar. En el primer caso, además de la tumoración, existía una comunicación arteriovenosa con la vena basílica, múltiples comunicaciones arteriovenosas en la zona hipotenar y zonas de microfístulas. En el segundo caso, había un aneurisma arteriovenoso del arco palmar superficial con vasos de la arteria radial y de la cubital. Los pacientes evolucionaron favorablemente, recibieron al alta al tercer día del posoperatorio y a los dos meses se reincorporaron a sus actividades laborales. La fístula arteriovenosa es una enfermedad con características peculiares, cuyo diagnóstico, tratamiento y evolución dependen de su localización anatómica y de la etapa clínica en que se encuentre. Un diagnóstico precoz y tratamiento oportuno brindarán resultados satisfactorios(AU)

Arteriovenous fistula is the abnormal communication between an artery and a vein with blood return to the cardiac cavities without passing through the capillary bed. The objective of this work is to describe the characteristics of the arteriovenous fistula of the hand. Two patients who were admitted to the Arteriology Service of the National Institute of Angiology and Vascular Surgery in the year 2012 with antecedents of this disease were studied. On physical examination, the presence of a round shape tumor in the back of the hand was confirmed. The confirmatory diagnosis of arteriovenous fistula was given by eco-doppler color, CT angiography and surgery. This last procedure was initiated, in both cases, by approaching the humeral artery over the elbow flexure to control, if it occurred, some distal bleeding of the ulnar artery. In the first case, besides the tumor, there was an arteriovenous communication with the basilic vein, multiple arteriovenous communications in the hypothenar area and areas of micro fistulas. In the second case, there was an arteriovenous aneurism of the superficial palmar arch with vessels of the radial and cubital artery. The patients evolved favorably, they were discharged from hospital at the third day of the postoperative phase, and reincorporated to work in two months. Arteriovenous fistula is a disease that has peculiar characteristics which diagnosis, treatment and evolution depend on its anatomic location and clinical stage. An early diagnosis and an appropriate treatment will afford satisfactory results(AU)