Syncope with cardiac arrest as the first manifestation of two congenital left coronary artery-to-main pulmonary artery fistulae (original) (raw)
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Right coronary artery-to-pulmonary artery fistula, the role of echocardiography
Coronary artery fistula is an uncommon but hemodynamically significant anomaly of the coronary arteries, occurring as an incidental finding in 0.1% to 0.2% of coronary angiograms. Although half of the patients with a coronary artery fistula remain asymptomatic, the other half develops CHF, infective endocarditis, myocardial ischemia, or rupture of an aneurysm. This report is illustrative of the right coronary artery fistula to the right pulmonary artery in a 57-year-old male. The definitive diagnosis was made during transesophageal echocardiography and confirmed at operation.
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
OALib, 2016
Coronary artery fistulas (CAF) are precapillary communications between a coronary artery and a cardiac chamber or vessel. CAF have been described as the most common hemodynamically significant congenital coronary anomal. However, it remains a relatively uncommon clinical problem. Coronary fistulas originates slightly more common from the right than from the left coronary artery, but the bilateral fistulas-those that originate from both coronary arteries-accounts for only 5% of total cases. These bilateral fistulas have a unique tendency to terminate in the pulmonary artery. More than half of the bilateral and only 17% of unilateral fistulas, terminates in this manner [1]. CAF are believed to be embryological remnants of sinusoidal connections between the lumens of the primitive tubular heart. This was first described by Maude Abbott in 1908 [2]. These fistulas are usually discovered incidentally upon coronary angiography [3]. Their incidence in the overall population is reported about 0.002% and constitutes 0.13% of congenital cardiac lesion, however, they are found in 0.05% to 0.25% of patients who undergo coronary angiography. The most common site of drainage is the right ventricle seen in 41% of patients. Congenital CAFs usually result from abnormal embryological development of the myocardial vascular system. Acquired CAFs are seen after trauma, endovascular procedures like coronary angiography, endomyocardial biopsy etcor cardiac transplantation. True fistulas of the circulatory system are characterized by an ectatic vascular segment that shows aberrant flow connecting two vascular territories governed by large pressure differences. We report a case of double coronary to pulmonary artery fistula discovered during emergent coronary angiography for acute inferior wall ST-elevation myocardial infarction (STEMI) in a patient with no prior cardiac symptoms.
PP-081 Bilateral Coronary-Pulmonary Artery Fistula with Recent Coronary Artery Disease
International Journal of Cardiology, 2010
Case: A 10-yr-old male patient was admitted for chest pain to our hospital. The patient was free of other cardiac symptoms. At admission his blood pressure (100/70 mmHg) and heart rate (90 beat/minute) were normal. Physical examination revealed no pathologic findings. Biochemical and hematological parameters were in the normal range. Chest X-ray was normal. The electrocardiogram showed normal sinus rhythm, and there was no evidence of arrhytmia Transthoracic echocardiography revealed a large coronary sinus with absence of the right superior vena cava (RSVC). Suprasternal window of the TTE displayed a persitant left superior vena cava (PLSVC) which draining to the coronary sinus. Transesophageal echocardiography imaging of the midesophageal, bicaval view with the transducer steered through 90-120°suggested absence of the RSVC. To obtain more detailed information, cardiac angiography had been performed and absence of the R-SVC and presence of the PLSVC which draining to coronary sinus were identified. Conclusions: Absence of the RSVC in visceroatrial situs solitus is a rare event, occurring in 0.07%-0.13% of congenital cardiovascular malformations. The presence of PLSVC occurs in approximately 0.3% to 0.5% of the general population. An absent RSVC is always associated with a PLSVC, with a reported incidence of 0.1% In most of patients with PLSVC, RSVC is present. In most of cases LSVC drains into coronary sinus and hence the coronary sinus is enlarged. Bartram et al. reviewed 121 patients with persistent left SVC and absent RSVC. About half of these cases had no other congenital malformations. Most common congenital defects associated with combined great venous malformation were various types of atrial septal defects, endocardial cushion defects and tetralogy of Fallot. The hemodynamics of patients with agenesia of RSVC and isolated PLSVC connected to the right atrium is the same as that of healthy individuals, as a result, patients are mostly asymptomatic. However it may cause difficulties and serious complications in central venous catheterization, intracardiac electrode placement or during cardiopulmonary bypass. Detailed and accurate echocardiographic studies may identify this rare combined congenital defect, hence preventing future complications during invasive procedures. The diagnosis of persistent left superior caval vein once required diagnosis by catheterisation or angiocardiography or both, but now non-invasive diagnosis by echocardiography is possible.
Case reports in cardiology, 2016
Coronary artery anomalies are congenital changes in their origin, course, and/or structure. Most of them are discovered as incidental findings during coronary angiographic studies or at autopsies. A coronary artery fistulae involve a communication between a coronary artery and a chamber of the heart or any segment of the systemic or pulmonary circulation. We present herein the case of a 67-year-old man with a recent history of exertional angina and dyspnea to usual daily activities whose coronary angiogram revealed an interesting and incidental coronary-pulmonary artery large fistulae.
Coronary pulmonary artery fistula: A case series with review of the literature
Objective: To describe the clinical, angiographic profile and management strategies of patients of coronary pulmonary arterial fistulas presenting to a tertiary care center in a developing country. Methods: All patients with coronary pulmonary artery fistula (CPAF) diagnosed using coronary angiogram in last two years i.e. 2011-2013 in a tertiary care center in South India were included in the study. Ten adult patients were treated for coronary pulmonary artery fistulas. Results: Mean age was 56± 7.7 years (range 45-80 years) with no gender preponderance. Chest pain was the predominant symptom in 60 % of patients followed by giddiness and syncope. Only 20 % patients were found to have continuous or systolic murmur on auscultation. Majority of the fistulas were found to be originating from the left anterior descending artery (LAD), most commonly from proximal segment (n = 5). Majority (n = 9) responded to conservative management while one patient required surgical intervention. Conclusion: Coronary pulmonary arterial fistulas are rare coronary anomaly which often goes unnoticed. CPAF was most frequently seen in middle age with male preponderance arising from proximal LAD. Patients present with diverse clinical presentations and subtle clinical findings. Majority of them being functionally insignificant, need only conservative measures.
Coronary Anomaly and Coronary Artery Fistula as Cause of
2011
Coronary artery fistulas are rare anomalies of the coronary arteries that may sometimes cause symptoms by shunting blood flow away from the myocardial capillary network. We report the case of a 46-year old lady which shows the right coronary cusp giving rise to left main coronary artery called anomalous origin of a coronary artery (AOCA), and also a fistula between the left coronary artery and pulmonary artery. We describe our diagnostic approach and review the literature on the epidemiology, pathophysiology, the diagnostic modalities, and treatment options.