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Mohammed F, Ali Khan Z, Mohammed M, Foley J, Abdul-Waheed M, Akbar M, Kazimuddin M. Congenital Anomaly Diagnosis of Typical Cardiac Chest Pain Due to Thebesian Veins Draining Into the Left Ventricular Chamber: A Case Report and Review of Literature. Cureus 2024; 16:e59002. [PMID: 38800250 PMCID: PMC11127696 DOI: 10.7759/cureus.59002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2024] [Indexed: 05/29/2024] Open
Abstract
Thebesian veins are microfistulae that drain the coronary arteries directly into one or more chambers of the heart. Persistence of these anomalous connections into adulthood can lead to shunting of blood away from the myocardium causing typical chest pain symptoms with electrocardiogram changes consistent with ischemia. We describe a case of a 77-year-old female who underwent ischemic evaluation for her symptoms found to have significant Thebesian veins. We also engage in a comprehensive review of the literature finding consistencies in the way these cases are presented in the literature.
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Affiliation(s)
- Fawaz Mohammed
- Internal Medicine, University of Kentucky College of Medicine, Bowling Green, USA
| | - Zaina Ali Khan
- Internal Medicine, Deccan College of Medical Sciences, Hyderabad, IND
| | - Muna Mohammed
- General Surgery, Deccan College of Medical Sciences, Hyderabad, IND
| | - Jeffrey Foley
- Cardiology, University of Kentucky, Bowling Green, USA
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2
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Surgical repair of a right coronary artery fistula to the left ventricle. J Cardiol Cases 2023; 27:162-164. [PMID: 37012924 PMCID: PMC10066407 DOI: 10.1016/j.jccase.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 11/13/2022] [Accepted: 12/10/2022] [Indexed: 01/09/2023] Open
Abstract
A 17-year-old male complained of exertional dyspnea and was referred to our hospital after he was diagnosed with a right coronary artery fistula into the left ventricle. Surgical repair was considered to improve the symptoms. We identified the distal end of the right coronary artery entering the left ventricle under cardiopulmonary bypass with cardiac arrest. The fistula was transected at the distal end of the right coronary artery and closed at both ends without incision of the left ventricle. Coronary angiography revealed the patency of the right coronary artery and the peripheral branches four months after surgery. The coronary computed tomography four years and four months after operation showed no pseudoaneurysm formation, no thrombosis, and subsequent regression of the dilated right coronary artery. Learning objective The coronary artery fistula is a rare congenital anomaly, and the treatment strategies of the coronary fistula are controversial. We performed ligation of the coronary fistula under cardiac arrest on cardiopulmonary bypass without incision of the left ventricle. This strategy may contribute to the accurate identification and ligation of the fistula without pseudoaneurysm formation.
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Lee HJ, Kim JY. Coronary Artery Anomaly, What Radiologist Should Know? JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:84-101. [PMID: 36237368 PMCID: PMC9238192 DOI: 10.3348/jksr.2021.0169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 12/17/2021] [Accepted: 12/24/2021] [Indexed: 11/15/2022]
Abstract
심장 전산화단층촬영(이하 CT)은 현재 관상동맥기형을 진단하고, 평가하는 가장 정확한 진단 도구로 자리매김하였으며, 심장 CT 촬영 건수가 증가함에 따라 관상동맥기형을 종종 관찰할 수 있다. 본 종설은 관상동맥기형에서 영상의학과 의사들이 꼭 알아야 할 대표적인 기형의 CT 소견들에 대해 다루었다. 관상동맥기형의 종류를 3부분 즉, 기시부, 동맥 내, 그리고 연결 부위로 나누어 설명하였으며, 임상에서 볼 수 있는 대표적인 기형들 중심으로 다루었다. 특히 혈역학적 이상을 유발하거나, 급사의 위험이 있는 기형들의 CT상 위험한 해부학적 소견에 대해서는 자세히 기술하였다.
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Affiliation(s)
- Hyun Jin Lee
- Department of Radiology, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Jin Young Kim
- Department of Radiology, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
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Relationship between impaired repolarization parameters and poor cardiovascular clinical outcomes in patients with potentially serious coronary artery anomalies. Coron Artery Dis 2021; 31:e27-e36. [PMID: 34010185 DOI: 10.1097/mca.0000000000001061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Congenital coronary artery anomalies (CCAAs) have the potential for life-threatening complications, including malignant ventricular arrhythmias and sudden cardiac death (SCD). In this study, we aimed to evaluate the relationship between impaired repolarization parameters and poor cardiovascular clinical outcomes in patients with potentially serious CCAAs. METHODS This retrospective study included 85 potentially serious CCAA patients (mean age: 54.7 ± 13.6 years; male:44) who were diagnosed with conventional and coronary computed tomography angiography (CCTA). All patients underwent transthoracic echocardiography and 12-lead surface electrocardiography. Cardiac events were defined as sustained ventricular tachycardia or fibrillation, syncope, cardiac arrest and SCD. RESULTS The presence of interarterial course (IAC) was confirmed by CCTA in 37 (43.5%) patients. During a median follow-up time of 24 (18-50) months, a total of 11 (12.9%) patients experienced cardiac events. The presence of IAC was significantly more frequent and Tp-e interval, Tp-e/QTc ratio and frontal QRS/T angle (fQRSTa) were significantly greater in patients with poor clinical outcomes. Moreover, the presence of IAC, high Tp-e/QTc ratio and high fQRSTa were found to be independent predictors of poor clinical outcomes and decreased long-term cardiac event-free survival in these patients. A net reclassification index was +1.0 for the Tp-e/QTc ratio and +1.3 for fQRSTa which were confirmable for additional predictability of these repolarization abnormalities. CONCLUSION Impaired repolarization parameters, including wider fQRSTa, prolonged Tp-e interval, and increased Tp-e/QTc ratio, and IAC may be associated with poor cardiovascular clinical outcomes in potentially serious CCAA patients.
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Shah L, Kundapur D, Nosib S. Stolen from the coronaries: Left-to-Left shunts presenting as chest pain syndrome! BMJ Case Rep 2021; 14:e242425. [PMID: 33762294 PMCID: PMC7993208 DOI: 10.1136/bcr-2021-242425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2021] [Indexed: 11/03/2022] Open
Abstract
We present the case of a 61-year-old woman with chest pain syndrome. Cardiac catheterisation did not reveal atherosclerotic coronary disease. However, a haemodynamically significant fistula connecting the left coronary artery to the left atrial appendage was found to be the culprit through a left-to-left shunting mechanism. In this report, we review the pathophysiology of coronary artery fistulas and the mechanism by which these fistulas may lead to 'coronary steal syndrome'. Indications for interventional and surgical management are outlined. Ultimately, we suggest the consideration of coronary artery fistulas in the differential diagnosis of patients presenting with chest pain.
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Affiliation(s)
- Love Shah
- Internal Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Deeksha Kundapur
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Shravan Nosib
- Cardiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Maknojia A, Pride Y, Ghatak A, Lee J. Fistula Between the First Obtuse Marginal Branch of the Left Circumflex and the Left Ventricular Cavity: A Rare Anomaly. Cureus 2021; 13:e13316. [PMID: 33738160 PMCID: PMC7959876 DOI: 10.7759/cureus.13316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2021] [Indexed: 11/08/2022] Open
Abstract
Coronary-cameral fistulae (CCF) are rare, frequently incidental findings uncommonly noted during routine coronary angiography. They are nearly always congenital and are sometimes associated with other cardiac malformations. They can also be acquired due to trauma or chronic inflammation. These fistulae most commonly originate from the right coronary artery. The site of termination is usually the right ventricle (RV) and rarely the left ventricle (LV). Though nearly always asymptomatic and clinically insignificant, depending on their size and pressure gradient between communicating sites and terminating area, CCF can lead to pulmonary hypertension, LV dysfunction, and myocardial infarction. We describe the case of a 55-year-old woman who presented with worsening dyspnea and lower extremity edema. Transthoracic echocardiography demonstrated an ejection fraction of 55% with an RV systolic pressure of 67 mmHg. Right heart catheterization was performed to formally diagnose pulmonary hypertension and left heart catheterization was performed concurrently. This demonstrated a fistula between the first obtuse marginal branch of the left circumflex artery to the LV cavity. In this report, the authors provide a brief review of the presentation, diagnosis, complications, and management of CCF.
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Affiliation(s)
- Arish Maknojia
- Internal Medicine Department, Northside Hospital Gwinnett, Lawrenceville, USA
| | - Yuri Pride
- Cardiology Department, Cardiovascular Group, Lawrenceville, USA
| | - Abhijit Ghatak
- Cardiology Department, Cardiovascular Clinic of North Georgia, Lawrenceville, USA
| | - Jin Lee
- Internal Medicine Department, Northside Hospital Gwinnett, Lawrenceville, USA
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Ahmed MF, Mubin A, Syed R, Mahmood AK, Sahni S. Multivessel Coronary Artery Fistula Presenting as Coronary Steal Syndrome Leading to Cardiac Arrest. Cureus 2020; 12:e8358. [PMID: 32617229 PMCID: PMC7325350 DOI: 10.7759/cureus.8358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The coronary steal phenomenon refers to myocardial ischemia caused by the diversion of blood away from normal myocardial circulation. A coronary artery fistula (CAF) is an abnormality of the coronary anatomy characterized by the aberrant termination of a coronary artery or its branches into cardiac chambers or great vessels. Although CAFs are often thought to be asymptomatic, fistulas that diverge a significant amount of blood flow and decrease the normal perfusion of myocardial tissue can cause ischemia and can present with acute coronary syndrome. We describe a unique case of a 70-year-old woman with no coronary artery disease (CAD) undergoing ventricular fibrillation and sudden cardiac arrest from myocardial ischemia secondary to coronary steal brought on by multivessel CAFs. This case was unique in that fistulas originating from the left anterior descending and from the circumflex artery draining into the left heart chambers are the least frequently observed. To our knowledge, only two other reports in the literature, demonstrating sudden cardiac arrest in patients with left anterior descending to left ventricle fistulas with no CAD, exist. The case presented, along with the literature reviewed, demonstrates that CAFs may be an important part of the differential diagnosis of symptoms of chest pain and myocardial ischemia, particularly in middle-aged adults with no history of coronary artery disease or related comorbidities.
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Affiliation(s)
- Muhammad F Ahmed
- Internal Medicine, Brookdale Hospital Medical Center, Brooklyn, USA
| | - Anaam Mubin
- Internal Medicine, Saba University School of Medicine, The Bottom, NLD
| | - Rumman Syed
- Internal Medicine, Brookdale University Hospital and Medical Center, New York, USA
| | - Abdullah K Mahmood
- Internal Medicine, Brookdale University Hospital and Medical Center, New York, USA
| | - Sonu Sahni
- Internal Medicine, Brookdale University Hospital Medical Center, New York, USA.,Research Medicine, New York Institute of Technology College of Osteopathic Medicine, New York, USA.,Primary Care, Touro College of Osteopathic Medicine, New York, USA
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Das KM, Almansoori TM, Momenah TS, Gorkom KNV. MDCT evaluation of intramyocardialsinusoids-coronary artery communications in a neonate with pulmonary atresia and intact ventricular septum. Indian J Radiol Imaging 2020; 30:77-80. [PMID: 32476754 PMCID: PMC7240892 DOI: 10.4103/ijri.ijri_277_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 09/10/2019] [Accepted: 10/23/2019] [Indexed: 11/16/2022] Open
Abstract
A patient of tetrology of Fallot with complete atresia of the pulmonary outflow tract with ventriculocoronary connections is presented. MDCT imaging revealed left coronary sinus, with a large fistula draining into the free wall of hypoplastic right ventricular cavity with tortuous channel arising from right ventricular outflow, and communicating with proximal limb of the fistula forming a complete loop suggesting a right ventricle–to – left coronary sinus sinusoid.
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Affiliation(s)
- Karuna M Das
- Department of Radiology, College of Medicine and Health Sciences, Al Ain, UAE
| | - Taleb M Almansoori
- Department of Paediatric Cardiology, Prince Salman Heart Center, King Fahad Medical City, Riyadh, Saudi Arabia
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Abstract
Coronary–cameral fistulas (CCFs) are mostly congenital in origin and rarely acquired. Clinical symptoms are decided by the hemodynamic significance of the coronary fistula. Even in asymptomatic patients, it is essential to know about coronary CCF particularly if the patient is to undergo cardiac surgery with cardioplegic cardiac arrest. Incidental finding of coronary CCF should never be ignored. Intraoperative myocardial protection and methods used are significantly influenced by such fistula.
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Affiliation(s)
- Monish S Raut
- Department of Cardiac Anaesthesiology, Artemis Hospitals, Gurgaon, Haryana, India
| | - Vijay Mohan Hanjoora
- Department of Cardiac Anaesthesiology, Artemis Hospitals, Gurgaon, Haryana, India
| | - Akhil Govil
- Department of Cardiac Surgery, Artemis Hospitals, Gurgaon, Haryana, India
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Abubakar H, Ahmed AS, Adam O, Yassin AS. Three vessel coronary artery-left ventricular multiple micro-fistulas: a rare angiographic finding. Oxf Med Case Reports 2018; 2018:omy053. [PMID: 30094044 PMCID: PMC6077794 DOI: 10.1093/omcr/omy053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 04/18/2018] [Accepted: 05/30/2018] [Indexed: 11/24/2022] Open
Abstract
A 54-year-old woman presents with a long history exertional chest pain and was found to have left ventricular systolic dysfunction on trans-thoracic echocardiogram. Coronary angiography revealed no evidence of atherosclerotic coronary artery disease and showed multiple micro-fistulae draining from all three major coronary arteries to the left ventricle. This rare abnormality is the result of failure of obliteration of intra-trabecular embryonic sinusoids and may cause myocardial ischemia through the coronary steal mechanism.
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Affiliation(s)
- Hossam Abubakar
- Department of Internal Medicine, Wayne state University, Detroit, MI 48201, USA
| | - Ahmed S Ahmed
- Department of Cardiovascular Medicine, St. Bernard Heart and Vascular, Jonesboro, AR 74201, USA
| | - Omeralfaroug Adam
- Department of Internal Medicine, Wayne state University, Detroit, MI 48201, USA
| | - Ahmed S Yassin
- Department of Internal Medicine, Wayne state University, Detroit, MI 48201, USA
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Frías-Ordoñez JS, Peña-Sinco I, Gómez-Segura G. Coronary cameral fistula: case report. CASE REPORTS 2018. [DOI: 10.15446/cr.v4n2.69483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introducción. Una fístula coronaria se define como la comunicación entre una arteria coronaria y una cámara cardiaca o cualquier segmento de la circulación sistémica o pulmonar. Su incidencia en series angiográficas y población general es muy baja y, en general, cursan de modo asintomático, aunque en raras ocasiones presentan significancia hemodinámica. Su localización en cavidades izquierdas es menos frecuente. Presentación del caso. Paciente masculino de 52 años quien presenta angina de esfuerzo, por lo que fue estratificado de modo invasivo encontrándose una fístula coronaria de la arteria descendente anterior al ventrículo izquierdo. Ante dichos hallazgos, le fue solicitada resonancia magnética nuclear cardiaca como estudio complementario para determinar conducta terapéutica a futuro; sin embargo, el paciente no asistió a controles, ni se le realizó dicho examen. Discusión. Las fístulas coronarias que causan enfermedad arterial coronaria son raras y el drenaje de una fístula coronaria a ventrículo izquierdo es aún más infrecuente. La importancia fisiopatológica de una fístula coronaria está relacionada con el volumen de sangre que fluye y el gradiente de presión a través de la comunicación. La mayoría de fístulas coronarias son diagnosticadas incidentalmente en un cateterismo cardíaco; sin embargo, algunas de estas presentan significancia clínica, siendo sintomáticas y causando complicaciones, por lo que requieren tratamiento a corto plazo. Conclusiones. En algunos casos, las pruebas complementarias iniciales en pacientes con clínica de isquemia miocárdica, realizadas de modo no invasivo, permiten sospechar la presencia de fístulas coronarias. La angiografía coronaria continúa siendo la prueba de mayor precisión diagnostica. Además, se deben tener en cuenta las características anatómicas y fisiológicas para definir si requieren manejo y si este se hará por vía percutánea o quirúrgica.
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Yun G, Nam TH, Chun EJ. Coronary Artery Fistulas: Pathophysiology, Imaging Findings, and Management. Radiographics 2018; 38:688-703. [DOI: 10.1148/rg.2018170158] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Gabin Yun
- From the Department of Radiology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 436-707, Republic of Korea
| | - Tae Hyun Nam
- From the Department of Radiology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 436-707, Republic of Korea
| | - Eun Ju Chun
- From the Department of Radiology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 436-707, Republic of Korea
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Kim CY, Choi JY, Kim KS. A coronary artery fistula having connection between 2 coronary arteries and the left ventricle: A case report. Medicine (Baltimore) 2017; 96:e8546. [PMID: 29137066 PMCID: PMC5690759 DOI: 10.1097/md.0000000000008546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Cases of coronary artery fistula having a connection with the cardiac cavity are rare. Here, we report a case in which 2 coronary arteries empty into the left ventricular cavity together. PATIENT CONCERNS A 63-year-old woman who was diagnosed as having hypertension 20 years prior presented with dyspnea. DIAGNOSES The coronary angiography revealed coronary artery fistula. INTERVENTIONS Chest X-ray showed pulmonary edema. Transthoracic echocardiography revealed moderately decreased left ventricular (LV) function and increased LV end-diastolic volume and mass index. Coronary angiography and cardiac computed tomography revealed that 2 coronary arteries joined together at the distal end and directly drained into the left ventricular cavity bypassing the myocardial capillary vessels. We started medical treatment for heart failure with an angiotensin-converting-enzyme inhibitor, loop diuretic, and spironolactone. OUTCOMES The pulmonary edema improved rapidly. The patient did not experience dyspnea after discharge, and follow-up echocardiography showed improved cardiac function. MAIN LESSON Coronary artery fistula could be found incidentally on coronary angiography performed for varied reasons. Physicians must decide carefully whether the fistula needs to be treated in view of the clinical context.
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Iyer P, Yelisetti R. Multiple left anterior descending coronary artery to left ventricular fistula - A case series and literature review. J Community Hosp Intern Med Perspect 2017; 7:258-261. [PMID: 29046757 PMCID: PMC5637639 DOI: 10.1080/20009666.2017.1369380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 08/10/2017] [Indexed: 11/23/2022] Open
Abstract
Coronary artery fistulas (CAFs) are found in 0.3–0.8% of patients who undergo coronary angiography. CAFs are defined as single or multiple, small or large direct communications that arise from one or more coronary arteries and enter into one of the four cardiac chambers or major vessels. We present two cases of multiple coronary artery fistulas arising from diagonal and left anterior descending (LAD) branches of left coronary artery draining into the left ventricle. In both the cases, No intervention was performed. Of the congenital fistulas, two major groups are identified: solitary CAFs or coronary artery-left ventricular multiple micro-fistulas (CALVMMFs). Noninvasive techniques such as transthoracic echocardiography, transesophageal echocardiography and magnetic resonance imaging are becoming increasingly popular for diagnosis and follow-up of CAFs. Despite the advent of these newer non-invasive modalities, coronary angiography remains the gold standard for diagnosis. Treatment of CAFs is indicated when the patients are symptomatic with left ventricular volume overload, myocardial ischemia, left ventricular dysfunction or in the presence of a large or increasing left-to-right shunt. If the fistula is small and hemodynamically insignificant, it can be managed with conservative management. Multiple left anterior descending to left ventricle (LV) fistulas are extremely rare and, as per our literature review, we noted only a few case reports of coronary artery fistulas between branches of LAD and left ventricle.
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Affiliation(s)
- Praneet Iyer
- Department of Pulmonary and Critical Care, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Rishitha Yelisetti
- Department of Internal Medicine, Seton Hall University of Health and Medical Science at St Francis Medical Center, Trenton, NJ, USA
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15
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Cernica D, Bordi L, Beganu E, Rodean I, Benedek I. Multiple Coronary Chamber Microfistulas or Persistent Thebesian Vessels? JOURNAL OF INTERDISCIPLINARY MEDICINE 2017. [DOI: 10.1515/jim-2017-0061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Coronary fistulas are rare, not gender-specific congenital conditions, consisting of communications between the coronary arteries and either another coronary vessel or a cardiac chamber. In contrast to large fistulas, small fistulas, named “minimae cordis veneae” or the Thebesius venous system, are draining into heart chambers and form a vascular network in the cardiac lumen. In this article, we present the case of a 72-year-old female with a significant history of cardiovascular disease, admitted to our clinic because of rest dyspnea, fatigue, and minimal chest pain. The 12-lead electrocardiogram showed a trifascicular block (a second-degree atrioventricular block Mobitz II, associated with a right bundle branch block and left anterior fascicle block) and negative T waves in DII, DIII, aVF, V4–V6 leads. An invasive coronary angiography was performed, which revealed no significant atherosclerotic lesions. However, a persistent capillary blush was present at the apex site of the left ventricular chamber, draining from the distal segments of both the anterior descending coronary artery and the posterior interventricular coronary artery. The intramural vascular network generating a left ventricle angiogram image of this kind was suggestive for persistent Thebesian vessels connecting the two coronaries with the left ventricular chamber.
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Affiliation(s)
- Daniel Cernica
- Center of Advanced Research in Multimodality Cardiac Imaging, Cardio Med Medical Center , Tîrgu Mureș , Romania
| | - Lehel Bordi
- Center of Advanced Research in Multimodality Cardiac Imaging, Cardio Med Medical Center , Tîrgu Mureș , Romania
| | - Elena Beganu
- Center of Advanced Research in Multimodality Cardiac Imaging, Cardio Med Medical Center , Tîrgu Mureș , Romania
| | - Ioana Rodean
- Center of Advanced Research in Multimodality Cardiac Imaging, Cardio Med Medical Center , Tîrgu Mureș , Romania
| | - Imre Benedek
- Center of Advanced Research in Multimodality Cardiac Imaging, Cardio Med Medical Center , Tîrgu Mureș , Romania
- University of Medicine and Pharmacy , Tîrgu Mureș , Romania
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Snipelisky D, Reddy YNV, Lennon RJ, Crusan DJ, Rihal CS, Lapeyre AC. Cardiac Structural Changes and Long-Term Survival in Patients With Prominent Thebesian Veins. Am J Cardiol 2016; 118:1264-1267. [PMID: 27614851 DOI: 10.1016/j.amjcard.2016.07.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 07/21/2016] [Accepted: 07/21/2016] [Indexed: 12/20/2022]
Abstract
Although rare, numerous case reports suggest that Thebesian veins confer increased morbidity and mortality. No study has evaluated their effects on cardiac structure or long-term patient outcomes. Patients undergoing coronary angiogram at the study institution from October 2002 and January 2015 were assessed for a diagnosis of prominent Thebesian veins. A matched control group was created and comparisons between clinical, echocardiographic, and survival measures were made. Of 50,116 total patients, 31 (0.06%) were found to have prominent Thebesian veins on angiography and were compared with a matched control group of 596 patients. Patients were matched for age, gender, angiogram date, location and extent of coronary disease, and dominance. Demographic and clinical data were similar between cohorts, with a median follow-up period of 26 months. Patients with Thebesian veins had lower Doppler E wave (0.7 vs 0.8; p = 0.007) and A wave (0.6 vs 0.8; p = 0.001) mitral inflow velocities suggesting some decrease in normal mitral inflow, potentially due to direct shunting into the ventricle from the Thebesian vein network. However, there was no observed difference in left ventricular size or ejection fraction between groups. There was also no significantly increased mortality associated with the presence of Thebesian veins (hazard ratio 1.11, 95% CI 0.58 to 2.13). In conclusion, although previous reports have suggested adverse outcomes from Thebesian veins, our case-control study demonstrated no significant associated adverse cardiac structural changes or increase in mortality, although patients with Thebesian veins were noted to have a decrease in mitral inflow velocities.
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Affiliation(s)
- David Snipelisky
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Yogesh N V Reddy
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ryan J Lennon
- Division of Biomedical Statistics and Informatics, Department of Information Technology, Mayo Clinic, Rochester, Minnesota
| | - Daniel J Crusan
- Division of Biomedical Statistics and Informatics, Department of Information Technology, Mayo Clinic, Rochester, Minnesota
| | - Charanjit S Rihal
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Andre C Lapeyre
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
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Cerit L, Gulsen K, Kemal H, Akpınar O. A case of coronary microfistula: A newborn microfistula. Indian Heart J 2016; 68:192-3. [DOI: 10.1016/j.ihj.2015.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 11/16/2015] [Indexed: 10/22/2022] Open
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18
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A case of double fistulas of right coronary artery to LVOT and LAD. Int J Cardiol 2016; 203:379-80. [DOI: 10.1016/j.ijcard.2015.10.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 10/13/2015] [Indexed: 11/30/2022]
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19
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Coronary artery fistula: a review. Cardiovasc Pathol 2015; 24:141-8. [DOI: 10.1016/j.carpath.2014.01.010] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 01/31/2014] [Accepted: 01/31/2014] [Indexed: 11/19/2022] Open
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20
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Alam R, Skehan J, Gunarathne A. A significant 'coronary steal' by thebesian veins, a rare congenital coronary defect masquerading as acute coronary syndrome. BMJ Case Rep 2015; 2015:bcr-2014-208880. [PMID: 25819822 DOI: 10.1136/bcr-2014-208880] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Rajib Alam
- Department of Cardiology, Glenfield Hospital, Leicester, UK
| | - John Skehan
- Department of Cardiology, Glenfield Hospital, Leicester, UK
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21
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Mowafy A, El-Said H. Unusual presentation of a huge right coronary artery fistula; Technical issues with device closure. Egypt Heart J 2014. [DOI: 10.1016/j.ehj.2013.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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22
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An isolated giant coronary cameral fistula—a case report. Indian J Thorac Cardiovasc Surg 2014. [DOI: 10.1007/s12055-014-0277-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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23
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Massive fistulization into the left ventricle of a transplanted heart. Herz 2014; 40 Suppl 1:56-8. [PMID: 24763436 DOI: 10.1007/s00059-014-4077-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 11/19/2013] [Accepted: 02/04/2014] [Indexed: 01/09/2023]
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24
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Sohn J, Song JM, Jang JY, Sun BJ, Kim DH, Kang DH, Song JK. Coronary artery fistula draining into the left ventricle. J Cardiovasc Ultrasound 2014; 22:28-31. [PMID: 24753806 PMCID: PMC3992345 DOI: 10.4250/jcu.2014.22.1.28] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 01/10/2014] [Accepted: 02/18/2014] [Indexed: 11/22/2022] Open
Abstract
We present a case of 48-year-old male who presented with coronary artery fistula draining into left ventricle. Transthoracic echocardiography showed abnormal blood flow draining into left ventricle, with enlarged coronary arteries and multiple vascular structures around ventricular myocardium. Coronary computed tomography revealed dilatation of entire left coronary artery which was wrapping around left ventricle, and draining into the posterior side of left ventricle. He did not undergo any invasive treatment, because he was not symptomatic.
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Affiliation(s)
- Jihyun Sohn
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong-Min Song
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Yoon Jang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byung Joo Sun
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dae-Hee Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Duk-Hyun Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Kwan Song
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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25
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Uyar IS, Akpinar B, Senarslan O, Sahin V, Uc H. Multiple coronary fistulae to left ventricle, with acute myocardial infarction. Asian Cardiovasc Thorac Ann 2014; 23:561-3. [PMID: 24585292 DOI: 10.1177/0218492314522045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A rare case of myocardial infarction secondary to multiple coronary artery fistulae is described. Coronary angiography showed the fistulae originating from the distal septal branch of the left anterior descending artery and distal branches of the right coronary and circumflex arteries, and drained into the left ventricle. A myocardial perfusion scan showed a fixed perfusion defect.
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Affiliation(s)
- Ihsan Sami Uyar
- Cardiovascular Surgery Department, Sifa University, Izmir, Turkey
| | - Besir Akpinar
- Cardiovascular Surgery Department, Sifa University, Izmir, Turkey
| | | | - Veysel Sahin
- Cardiovascular Surgery Department, Sifa University, Izmir, Turkey
| | - Halil Uc
- Cardiovascular Surgery Department, Sifa University, Izmir, Turkey
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26
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Yuksel S, Yasar E, Nar G, Gulel O, Demircan S, Yilmaz O, Sahin M. Prevalence and characteristics of coronary-cameral communications in adult patients: coronary angiographic analysis of 16,573 patients. Med Princ Pract 2014; 23:336-9. [PMID: 24924735 PMCID: PMC5586900 DOI: 10.1159/000363183] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 04/27/2014] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE To analyze the coronary angiograms of patients with symptomatic heart disease in order to determine the frequency and characteristics of coronary-cameral communications (CCCs) in a single center. SUBJECTS AND METHODS The coronary angiograms of 16,573 patients with symptomatic heart disease performed from November 2001 to January 2011 were analyzed. The diagnosis of coronary fistula and coronary-cameral microcommunications (CCMCs) was made according to previously defined criteria. RESULTS Of the 16,573 patients, 15 (0.09%; 8 males and 7 females, mean age 63 ± 12 years) had CCCs, while coronary fistulas were identified in 2 (0.01%). In the first patient, the coronary fistula arose from the branches of the left anterior descending (LAD) artery and the right coronary artery (RCA) and drained into the right ventricle. In the second patient, the fistula originated from branches of the LAD artery, the circumflex (Cx) artery and the RCA and drained into the left ventricle. In 7 patients, the CCMCs originated from the LAD artery. In 3 patients, the Cx artery was the origin. The CCMCs originated from the RCA in 2 patients. In 1 patient the CCMC took its origin from the RCA and the Cx artery, while in 2 patients the CCMCs were associated with intracardiac masses in the left atrium and the right atrium, respectively. CONCLUSION The prevalence of CCCs in adult patients was low and that of large coronary fistulas was even lower; coronary fistulas are probably very rare in adult patients because the majority of them are detected and treated during childhood.
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Affiliation(s)
- Serkan Yuksel
- *Serkan Yüksel, Department of Cardiology, Faculty of Medicine, Ondokuz Mayýs University, TR-55139 Samsun (Turkey), E-Mail
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27
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Kawai H, Motoyama S, Sarai M, Ozaki Y. Dilated coronary arterial obstruction due to coronary artery microfistulae. J Cardiovasc Comput Tomogr 2013; 7:417-8. [PMID: 24331938 DOI: 10.1016/j.jcct.2013.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 10/03/2013] [Accepted: 11/04/2013] [Indexed: 11/29/2022]
Abstract
An 80-year-old asymptomatic man presented with ST-segment elevation in leads V1 to V5. Coronary CT angiography showed that microfistulae arising from multiple arteries may have led to myocardial infarction from intracoronary thromboembolism within the dilated left anterior descending (LAD).
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Affiliation(s)
- Hideki Kawai
- Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan.
| | - Sadako Motoyama
- Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan
| | - Masayoshi Sarai
- Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan
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28
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Unexpectedly abundant coronary Thebesian system: Possible cause of chest pain and abnormal electrocardiogram results. Int J Cardiol 2013; 168:4909-12. [DOI: 10.1016/j.ijcard.2013.07.097] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 07/08/2013] [Indexed: 11/19/2022]
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29
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Said SAM, Schiphorst RHM, Derksen R, Wagenaar L. Coronary-cameral fistulas in adults (first of two parts). World J Cardiol 2013; 5:329-336. [PMID: 24109496 PMCID: PMC3783985 DOI: 10.4330/wjc.v5.i9.329] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 07/05/2013] [Accepted: 08/29/2013] [Indexed: 02/06/2023] Open
Abstract
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.
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30
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Nakasuka K, Ito S. "Wedge effect" in stenosed coronary artery assessed using a PressureWire: change in pressure waveform during percutaneous coronary intervention in a patient with a coronary artery-left ventricular fistula. Heart Vessels 2013; 29:413-6. [PMID: 23812583 DOI: 10.1007/s00380-013-0385-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 06/13/2013] [Indexed: 11/25/2022]
Abstract
In this case report, we describe the recovery of abnormal coronary pressure waveform using a PressureWire Certus during percutaneous coronary intervention in a patient with severe stenosis in the proximal segment of the left anterior descending coronary artery. Since the diastolic pressure in the distal left anterior descending coronary artery was lower than that in the aorta, the pressure waveform before percutaneous coronary intervention represented the left ventricular pressure through a fistula due to a "wedge effect" in the stenosis as if the pulmonary artery wedge pressure determined by a Swan-Ganz catheter reflected the pressure in the distal portion (left atrium). We diagnosed this case coronary artery-left ventricular fistula based on the above findings. PressureWire Certus may be a valuable tool with which to estimate the hemodynamics in a patient with a coronary anomaly.
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Affiliation(s)
- Kosuke Nakasuka
- Division of Cardiology, Nagoya City East Medical Center, 1-2-23 Wakamizu, Chikusa-ku, Nagoya, Aichi, 464-8547, Japan,
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31
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Khoueiry G, Baydoun H, Abi Rafeh N, McCord D, Olkovky Y. Persistent Thebesian Vessels Involving the Right and Left Ventricles Leading to Coronary Steal Phenomena and Ischemia. CONGENIT HEART DIS 2013; 9:E61-5. [DOI: 10.1111/chd.12077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/05/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Georges Khoueiry
- Department of Cardiology; Staten Island University Hospital; Staten Island NY USA
| | - Hassan Baydoun
- Department of Medicine; Staten Island University Hospital; Staten Island NY USA
| | - Nidal Abi Rafeh
- Department of Cardiology; Staten Island University Hospital; Staten Island NY USA
| | - Donald McCord
- Department of Cardiology; Staten Island University Hospital; Staten Island NY USA
| | - Yefim Olkovky
- Department of Cardiology; Staten Island University Hospital; Staten Island NY USA
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32
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Galli E, Rizza A, Remoli E, Tognarelli A, Palmieri C, Chiappino D, Berti S. Coronary-to-bronchial artery fistula in a patient with angina. J Cardiol Cases 2012; 7:e45-e47. [PMID: 30533118 DOI: 10.1016/j.jccase.2012.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Revised: 09/13/2012] [Accepted: 10/18/2012] [Indexed: 01/07/2023] Open
Abstract
Coronary-to-bronchial artery fistulae are the most common found in adulthood and have often been associated with bronchiectasis and other abnormalities of pulmonary parenchyma. In this study we describe an unusual case in which circumflex coronary artery-to-left bronchial artery fistula was associated with the presence of extensive aneurysmatic dilatation of thoracic arteries. <Learning objective: This report deals with the case of a coronary-to-bronchial artery fistula (CAF) as the cause of atypical angina in a patient with normal coronary arteries. The concomitant finding of aneurysmatic dilatation of thoracic arteries controindicated an invasive approach. Medical therapy with vasodilators and anti-anginal drugs was soon started proving to be efficacious in symptoms relief.>.
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Affiliation(s)
- Elena Galli
- Scuola Superiore S. Anna, Pisa, Italy.,UO Cardiologia Adulti, Fondazione Toscana Gabriele Monasterio, Massa, Italy
| | - Antonio Rizza
- UO Cardiologia Adulti, Fondazione Toscana Gabriele Monasterio, Massa, Italy
| | - Ettore Remoli
- UO Diagnostica per Immagini, Fondazione Toscana Gabriele Monasterio, Massa, Italy
| | - Andrea Tognarelli
- UO Cardiologia Adulti, Fondazione Toscana Gabriele Monasterio, Massa, Italy
| | - Cataldo Palmieri
- UO Cardiologia Adulti, Fondazione Toscana Gabriele Monasterio, Massa, Italy
| | - Dante Chiappino
- UO Diagnostica per Immagini, Fondazione Toscana Gabriele Monasterio, Massa, Italy
| | - Sergio Berti
- UO Cardiologia Adulti, Fondazione Toscana Gabriele Monasterio, Massa, Italy
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33
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Multiple coronary artery fistulae with biventricular hypertrophy. J Echocardiogr 2012; 10:132-4. [PMID: 27278348 DOI: 10.1007/s12574-012-0136-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 07/13/2012] [Accepted: 07/17/2012] [Indexed: 10/28/2022]
Abstract
Here, we report a case of multiple coronary artery fistulae with biventricular hypertrophy. The initial diagnosis of multiple coronary artery fistulae, draining into the left as well as the right ventricle, was made by standard transthoracic 2-dimensional and Doppler echocardiography. Later, multiple coronary fistulae communicating with the left ventricle through persistent sinusoids were diagnosed by coronary angiography.
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34
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Jung Y, Kim HJ, Yoon CH. Severe form of persistent thebesian veins presenting as ischemic heart disease. Korean Circ J 2012; 42:714-7. [PMID: 23170102 PMCID: PMC3493811 DOI: 10.4070/kcj.2012.42.10.714] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 03/09/2012] [Accepted: 03/23/2012] [Indexed: 02/07/2023] Open
Abstract
Coronary artery fistula is a rare congenital anomaly. Most patients with this anomaly are asymptomatic, but some may develop heart failure, myocardial ischemia or arrhythmias. We report a case of a patient who presented with myocardial ischemia secondary to persistent Thebesian veins. Coronary angiography demonstrated a marked capillary blush draining into the left ventricular cavity through multiple microfistulae from the left anterior descending artery, left circumflex artery and right coronary artery. The patient was discharged without chest pain and was medically maintained with a beta-blocker and angiotensin converting enzyme inhibitor.
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Affiliation(s)
- Younghee Jung
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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35
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Mangukia CV. Coronary artery fistula. Ann Thorac Surg 2012; 93:2084-92. [PMID: 22560322 DOI: 10.1016/j.athoracsur.2012.01.114] [Citation(s) in RCA: 155] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 01/25/2012] [Accepted: 01/31/2012] [Indexed: 01/29/2023]
Abstract
Although coronary arterial fistula is rare, it is one of the most common among the coronary artery anomalies. Coronary arterial fistula most commonly affects the right side of the heart. It may occur isolated or along with congenital heart diseases. Angiography remains the best investigation for diagnosing the disease. Unless very large and hemodynamically significant, it is usually asymptomatic in younger patients. With increasing age, symptoms begin to appear, and the incidence of complication rises. Treatment by transcatheter or surgical closure gives the best results, provided this is performed early in the course of the disease. This review was prepared by searching the terms "coronary artery fistula," "coronary cameral fistula," "surgical management of coronary arterial fistula," "MDCT in coronary artery fistula," and "multiple coronary artery fistulae" in Google Scholar, PubMed, and PubMed Central and exploring the related articles shown on the side of page.
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36
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Bartoloni G, Giorlandino A, Calafiore AM, Caltabiano R, Cosentino S, Algieri G, Pucci A. Multiple coronary artery-left ventricular fistulas causing sudden death in a young woman. Hum Pathol 2012; 43:1520-3. [PMID: 22521075 DOI: 10.1016/j.humpath.2011.12.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2011] [Revised: 12/14/2011] [Accepted: 12/27/2011] [Indexed: 11/25/2022]
Abstract
Multiple coronary artery fistulae arising from right and left coronary arteries were found at autopsy in a 22-year-old woman, dying suddenly while playing football. This is the fifth pathologic description of this finding with biventricular involvement. We found microscopic evidence of postischemic scars and foci of myocardial calcifications in the left ventricular wall.
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37
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Abstract
Right coronary to left ventricular fistulas are rare. We report a patient who presented with unstable angina and was found to have a large right coronary to left ventricular fistula.
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Affiliation(s)
- Yan Zhang
- Department of Cardiovascular Surgery, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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38
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Jiang Z, Chen H, Wang J. Right coronary artery fistula to left ventricle treated by transcatheter coil embolization: a case report and literature review. Intern Med 2012; 51:1351-3. [PMID: 22687840 DOI: 10.2169/internalmedicine.51.6787] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A coronary artery fistula between a coronary artery and a cardiac chamber is a rare condition. We reported a case of right coronary artery fistula to the left ventricle in a 57-year-old man who had 2-year history of chest pain and exercise dyspnea without significant coronary atherosclerosis with abnormal left ventricular size and function. It was important to recognize this anomaly and our experience showed that transcatheter occlusion of coronary artery fistula was a safe and effective procedure in the presence of symptoms of congestive heart failure, significant left-to-right shunt or refractory to medical treatment.
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Affiliation(s)
- Zhenni Jiang
- Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhe Jiang University, China
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39
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Chattopadhyay S, John J. Aortic regurgitation and coronary microfistulae: double jeopardy causing myonecrosis. Cardiology 2011; 118:227-32. [PMID: 21701172 DOI: 10.1159/000328644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Accepted: 04/06/2011] [Indexed: 11/19/2022]
Abstract
We describe a 3-case series of patients with a rare combination of mild-to-moderate aortic regurgitation and coronary microfistulae but nonobstructed epicardial coronary arteries who presented with symptoms of unstable angina and had confirmed myonecrosis. A plausible pathophysiological mechanism for this phenomenon and its clinical implication are discussed.
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40
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Non-invasive recognition of generalized coronary arteriosystemic fistulae by contrast echocardiography and multidetector CT. Int J Cardiovasc Imaging 2011; 27:749-53. [DOI: 10.1007/s10554-011-9866-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Accepted: 04/02/2011] [Indexed: 12/22/2022]
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41
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Coronary-cameral fistula with angina pectoris. Case Rep Med 2010; 2010:362532. [PMID: 21209744 PMCID: PMC3014857 DOI: 10.1155/2010/362532] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2010] [Accepted: 10/11/2010] [Indexed: 02/07/2023] Open
Abstract
Coronary-cameral fistula (CCF) is an anomalous connection between a coronary artery and cardiac chamber. Most of CCFs are discovered incidentally during angiographic evaluation for coronary vascular disorder. We report a case of CCF with angina pectoris. Selective coronary arteriography revealed diffuse CCF involving the left anterior descending artery (LAD) emptying into left ventricle (LV) and showed significant two-vessel coronary artery stenosis.
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42
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Caliskan K, Balk AHHM, Wykrzykowska JJ, van Geuns RJ, Serruys PW. How should I treat an unusual referral for heart transplantation? EUROINTERVENTION 2010; 5:861-5. [PMID: 20142204 DOI: 10.4244/eijv5i7a144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND A 55 years old man was referred for cardiac transplantation because of intractable angina and fatigue. INVESTIGATION Physical examination, laboratory test, echocardiography, exercise ECG, MRI and coronary arteriography. DIAGNOSIS Multiple coronary artery fistulae. MANAGEMENT Beta-blockers, angiotensin-converting enzyme inhibitor ICD.
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43
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Chattopadhyay S, Wahab N, O'Reilly K. Persistent thebesian veins presenting with myocardial ischemia. Can J Cardiol 2010; 26:e31-2. [PMID: 20101368 DOI: 10.1016/s0828-282x(10)70345-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- S Chattopadhyay
- Scunthorpe General Hospital, North Lincolnshire, United Kingdom.
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44
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Abstract
An 85-year-old woman underwent transthoracic echocardiography for the investigation of breathlessness and atypical chest discomfort. Clinical examination was unremarkable. A standard 12 lead ECG demonstrated anterior T wave inversion, but was otherwise normal. Transthoracic echocardiography demonstrated a normally functioning left ventricle with hypertrophy and trabeculation of the apical and lateral segments. Imaging with colour flow Doppler demonstrated blood flow from the epicardial surface into the left ventricular cavity through the hypertrophied segment of myocardium during diastole. A diagnosis of multiple, diffuse coronary-left ventricular fistulae predominantly of a large diagonal branch of the left anterior descending artery was made at coronary angiography. The patient responded well to oral beta-blockade, reporting an improvement in symptoms 2 months later in the outpatient clinic. The echocardiographic appearances of coronary fistulae may cause diagnostic confusion, particularly in the presence of myocardial hypertrophy and trabeculation.
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45
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Puri R, Dundon B, Worthley S, Worthley M. Thebesian Coronary System. Heart Lung Circ 2008; 17:414-5. [DOI: 10.1016/j.hlc.2008.03.082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2008] [Accepted: 03/12/2008] [Indexed: 10/22/2022]
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Krishnan U, Schmitt M. Images in cardiovascular medicine. Persistent thebesian sinusoids presenting as ischemic heart disease. Circulation 2008; 117:e315-6. [PMID: 18427138 DOI: 10.1161/circulationaha.107.748863] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Unni Krishnan
- Department of Cardiovascular Sciences, Clinical Sciences Wing, Glenfield Hospital, Groby Rd, Leicester, UK, LE3 9QP.
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47
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Confluence at distal end of multiple coronary artery fistulae: two cases treated with interventional approach. Chin Med J (Engl) 2008. [DOI: 10.1097/00029330-200803010-00022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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48
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Kouerinis IA, Deligianni M, Maniatis V, Elefteriadis I, Kourtesis A, Michalopoulos N. Giant congenital left main coronary artery fistula to the superior vena cava in an adult patient with coronary artery disease. J Thorac Cardiovasc Surg 2007; 134:1057-8. [PMID: 17903536 DOI: 10.1016/j.jtcvs.2007.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2007] [Accepted: 07/05/2007] [Indexed: 10/22/2022]
Affiliation(s)
- Ilias A Kouerinis
- Department of Cardiac Surgery, Aghia Sophia Children's Hospital, Athens, Greece.
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Itoi T, Satou H, Hamaoka K. Coronary flow characteristics of multiple coronary artery-left ventricular microfistulae in young monozygotic twins. Circ J 2007; 71:1492-5. [PMID: 17721035 DOI: 10.1253/circj.71.1492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Coronary artery multiple fistulae of the left ventricular chamber are extremely rare congenital malformations. We report on 13-year-old monozygotic twin brothers who have identical abnormalities of coronary flow reserve as well as the same morphological findings of multiple coronary fistulae of the 3 major coronary arteries to the left ventricular chamber. The left circumflex coronary artery (LCX) had abundant fine communications with the left ventricular chamber and had a higher flow rate than the left anterior-descending coronary artery. The coronary flow reserve obtained from the LCX was lower than the normal value matched for the same age group. The increased shunt flow resulted in enlargement of the left ventricular chamber. This is the first report of coronary flow characteristics in children with multiple coronary fistulae.
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Affiliation(s)
- Toshiyuki Itoi
- Department of Pediatric Cardiology and Nephrology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
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50
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Hwang BH, Hong SJ, Jeon SS, Choi JH, Lee HJ. The Effect of Phenylephrine on Cardiac Performance and Myocardial Oxygen Balance in Resuscitation from Hemorrhagic Shock. Korean J Anesthesiol 2007. [DOI: 10.4097/kjae.2007.52.5.571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Byung Hyun Hwang
- Department of Anesthesiology and Pain Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Sung Jin Hong
- Department of Anesthesiology and Pain Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Soon Shin Jeon
- Department of Anesthesiology and Pain Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jin Hwan Choi
- Department of Anesthesiology and Pain Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Hae Jin Lee
- Department of Anesthesiology and Pain Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
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