Fístula coronariana para ventrículo esquerdo: diagnóstico por tomografia computadorizada (original) (raw)
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Case report of coronary artery fistula
Medicine, 2019
Rationale: Unlike invasive coronary angiography and echocardiography, cardiac computed tomography (CCT) and cardiac magnetic resonance (CMR) imaging allow a coronary artery fistula (CAF) comprehensive evaluation focusing on both coronary and myocardial findings. Patient concerns: We present the case of an asymptomatic patient suspected for CAF and referred to our structure for cardiovascular evaluation. Diagnosis: The patient was diagnosed a CAF without coronary artery disease on the basis of CMR and CCT. Interventions: The patient underwent an invasive coronary angiography after which the medical staff decided not to surgically treat the CAF. Therefore, a conservative treatment was chosen with strict temporal monitoring. Outcomes: After less than 1 year follow-up, the patient presented stable conditions without complaints. Lessons: Multimodal non-invasive imaging has a key role in patient assessment for disease diagnosis providing better understanding for prognosis and treatment. Abbreviations: CAF = coronary artery fistula, CCT = cardiac computed tomography, CMR = cardiac magnetic resonance, CR = cinematic rendering, EDV = end-diastolic volume, EF = ejection fraction, ESV = end-systolic volume, LAD = left anterior descending artery, LCX = circumflex coronary artery, RCA = right coronary artery, SSFP = cine steady state free precession, STIR = short Tau inversion recovery, VR = volume rendering.
Journal of cardiology, 2007
Right coronary artery to left ventricle fistula is a rare type of coronary artery fistula among congenital coronary artery anomalies. Most patients exhibit no symptoms and some experience chest pain. Coronary angiography sometimes detects the presence of coronary artery fistula, but not coronary arteriosclerosis. A 76-year-old man with unstable angina was admitted because he did not respond to drug therapy. Coronary angiography showed three-vessel coronary artery disease and the contrast agent entered the left ventricle from the terminal of the right coronary artery during diastole. Multidetector-row computer tomography showed similar findings. The patient subsequently underwent coronary artery bypass grafting and obliteration of the coronary artery fistula. The chest pain was relieved and he is now in good condition.
Computed Tomography Assessment of Coronary Fistulas
Journal of Interdisciplinary Medicine
Coronary artery fistulas, a rare anomaly, are represented by an abnormal communication between the coronary arteries and other vascular structures or cardiac chambers and, in most cases, are detected incidentally. Regularly, they do not cause important pathological changes, but if the symptoms persist, they need to be treated. The hemodynamic impact depends on the localization and size of the fistulas. Noninvasive imaging techniques, such as magnetic resonance imaging and multislice computed tomography, are widely used for the detection of coronary anomalies. The presence of symptoms (angina, dyspnea) is the primary indication for the surgical or percutaneous closure of the communications; therefore, a systematic follow-up is indicated in all cases. We present four cases of coronary artery fistulas, without important hemodynamic complications, detected by multislice computed tomography coronary angiography.
A case of symptomatic coronary artery fistula
Nature Clinical Practice Cardiovascular Medicine, 2006
This article offers the opportunity to earn one Category 1 credit towards the AMA Physician's Recognition Award. Diagnosis Right coronary artery to coronary sinus fistula with coronary steal, exertional ischemia and ventricular arrhythmia. Management Coil embolization of coronary left ventricular fistula.
Echocardiography, 2011
A 49-year-old female who presented with 3 weeks of exertional chest pain had an abnormal mediastinal finding at chest x-ray imaging. Conventional, nongated computed tomography of the chest revealed a "mass" in proximity to the right atrium. 64-slice, cardiac gated computed tomographic coronary angiography, and transesophageal echocardiography delineated the "mass" as a coronary artery fistula structure. The fistula originated from the left main as a tubular vessel that continued into an aneurysmal sac-like cavity that emptied into the superior vena cava near the right atrium. Computed tomographic coronary angiography showed otherwise normal coronary arteries. Findings were ultimately confirmed at cardiac catheterization. Coronary steal was clinically diagnosed and she underwent surgical ligation and resection of the fistula and aneurysm. Her subsequent course was uncomplicated. (Echocardiography 2012;29:E69-E71)
Journal of the American College of Cardiology, 1985
A coronary-cameral fistula was inspected clinically by two-dimensional and pulsed Doppler ultrasound. At car• diac catheterization a fistulous connection between the left coronary artery and the right ventricle was observed. Contrast echocardiography using agitated saline solution injected into the aortic catheter clearly showed the pas-Congenital fistulas of the coronary arteries, first described by Krause in 1965 (l), may involve a variety of fistulous connections to the cardiac chambers or surrounding large vessels (2,3). In more than 90% of reported cases, the fistula drained into the systemic venous circulation (right ventricle, right atrium, pulmonary artery and coronary sinus), whereas there were only a few reported cases (4-6) in which it drained into the left ventricle. This report is the first to describe the connection of a left coronary artery fistula to both ventricles, the demonstration of which required con• trast echocardiography during the cardiac catheterization. Case Report A 3 year old asymptomatic girl had a heart murmur noted since the age of 6 months. A high-pitched grade 2/6 con• tinuous murmur was heard over the cardiac apex with sys• tolic and diastolic components of equal intensity. Serial electrocardiograms and chest rentgenograms were normal. A two-dimensional echocardiogram was performed using a Mark 600 ATL mechanical scanner with full spectral Dop• pler output and a 5 MHz transducer. An enlarged left coro• nary artery with two echolucent areas in the apical inter• ventricular septum was noted (Fig. I). Doppler insonation
Coronary Arteriovenous Fistula Originating From the Left Main Coronary Artery
Cureus
We report a case of coronary artery fistula arising from the left main coronary artery in a 62-year-old patient presenting with atrial fibrillation. He underwent a transthoracic echocardiogram which suggested a possible coronary artery fistula. Cardiac computed tomographic angiography and cardiac catheterization confirmed the diagnosis. Coronary artery fistula originated from the left main coronary artery, which is rare and terminated in the coronary sinus. Multi-modality imaging helps to delineate anatomy and decide treatment options. Small asymptomatic fistulas do not require treatment, and large or symptomatic fistulas need closure. Our patient was asymptomatic, and we opted for conservative management with close outpatient echocardiographic monitoring.
Congenital Heart Disease, 2007
We report 2 cases of infants presenting with a murmur shortly after birth and diagnosed with coronary artery fistulas with drainage into the left atrium. The first infant had a fistulous communication between the left main coronary artery and the left atrial appendage and presented with signs and symptoms of heart failure. The infant was repaired surgically in the first week of life. The second infant was asymptomatic and had a fistulous communication between the right coronary artery and the left atrium. The infant will have the fistula closed in the cardiac catheterization laboratory when the child is older. The literature on coronary artery fistulas is reviewed, and the diagnosis and management of coronary artery fistulas is discussed.