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Bashir H, Ahmed AA, Akhtar M, Beering AR, Ratajczak TM. A Rare Case of Left Main Coronary Artery Coronary Sinus Fistula in an 85-Year-Old Female. Cureus 2024; 16:e61320. [PMID: 38947675 PMCID: PMC11213488 DOI: 10.7759/cureus.61320] [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: 05/29/2024] [Indexed: 07/02/2024] Open
Abstract
Coronary arteriovenous fistulas (CAVFs) are congenital or acquired communications between the coronary arteries and coronary venous system, and they can also include other cardiac structures or vasculature. We discuss a case of a large fistula between the left main coronary artery and the right atrium in a geriatric patient with a history of gastrointestinal arteriovenous malformations (AVM). The occurrence of CAVFs, an uncommon cardiac irregularity, is particularly infrequent among older adults. Typically, it is discovered by chance when investigating symptoms such as shortness of breath or chest pain, where coronary angiography is necessary to determine the most effective treatment strategy. This case highlights the possible utility of evaluating CAVFs in patients with a history of gastrointestinal AVM who similarly present with clinical symptoms of high-output heart failure. Once identified, this could simplify the treatment approach and improve communication between healthcare providers to minimize the risk of harm to the patient.
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Affiliation(s)
- Hanad Bashir
- Cardiovascular Medicine, The Christ Hospital, Cincinnati, USA
| | - Ahmed A Ahmed
- Internal Medicine, Rochester Unity Hospital, Rochester, USA
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2
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Velázquez‐Castañeda R, De La Puente‐Tawil I, Molina‐Castillo S, Proaño‐Bernal L, Rodríguez‐Salazar MA, Masso‐Bueso S, Alexanderson‐Rosas E, Arenas‐Fabbri V. Coronary-cameral fistula in an infant patient: An incidental diagnosis. Clin Case Rep 2023; 11:e8172. [PMID: 38028060 PMCID: PMC10654555 DOI: 10.1002/ccr3.8172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/03/2023] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
Coronary artery fistula is a rare abnormal connection between the heart arteries. Patients may remain asymptomatic until adulthood, potentially experiencing life-threatening complications. Adequate monitoring and therapeutic management are essential.
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Affiliation(s)
| | | | | | - Leonardo Proaño‐Bernal
- Instituto Nacional de Cardiología Ignacio ChávezMexico CityMexico
- Universidad Nacional Autónoma de MexicoMexico CityMexico
| | | | | | - Erick Alexanderson‐Rosas
- Instituto Nacional de Cardiología Ignacio ChávezMexico CityMexico
- Universidad Nacional Autónoma de MexicoMexico CityMexico
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Shen Q, Lin C, Yao Q, Wang J, Zhou J, He L, Chen G, Hu X. Addition of gadolinium contrast to three-dimensional SSFP MR sequences improves the visibility of coronary artery anatomy in young children. Front Pediatr 2023; 11:1159347. [PMID: 37215588 PMCID: PMC10196256 DOI: 10.3389/fped.2023.1159347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 04/12/2023] [Indexed: 05/24/2023] Open
Abstract
Objective This study aims to compare the value of a gadolinium contrast-enhanced 1.5-T three-dimensional (3D) steady-state free precession (SSFP) sequence with that of a noncontrast 3D SSFP sequence for magnetic resonance coronary angiography in a pediatric population. Materials and methods Seventy-nine patients from 1 month to 18 years old participated in this study. A 3D SSFP coronary MRA at 1.5-T was applied before and after gadolinium-diethylenetriaminepentaaceticacid (DTPA) injection. The detection rates of coronary arteries and side branches were assessed by McNemar's χ2 test. The image quality, vessel length, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) of the coronary arteries were analyzed by the Wilcoxon signed-rank test. The intra- and interobserver agreements were evaluated with a weighted kappa test or an intraclass correlation efficient test. Results A contrast-enhanced scan detected more coronary arteries than a noncontrast-enhanced scan in patients under 2 years old (P < 0.05). The SSFP sequence with contrast media detected more coronary artery side branches in patients younger than 5 years (P < 0.05). The image quality of all the coronary arteries was better after the injection of gadolinium-DTPA in children younger than 2 years (P < 0.05) but not significantly improved in children older than 2 years (P > 0.05). The contrast-enhanced 3D SSFP protocol detected longer lengths for the left anterior descending coronary artery in children younger than 2 years and the left circumflex coronary artery (LCX) in children younger than 5 years (P < 0.05). SNR and CNR of all the coronary arteries in children younger than 5 years and the LCX and right coronary artery in children older than 5 years enhanced after the injection of gadolinium-DTPA (P < 0.05). The intra- and interobserver agreements were high (0.803-0.998) for image quality, length, SNR, and CNR of the coronary arteries in both pre- and postcontrast groups. Conclusion The use of gadolinium contrast in combination with the 3D SSFP sequence is necessary for coronary imaging in children under 2 years of age and may be helpful in children between 2 and 5 years. Coronary artery visualization is not significantly improved in children older than 5 years.
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Affiliation(s)
- Quanli Shen
- Department of Radiology, Children’s Hospital of Fudan University, Shanghai, China
| | - Chengxiang Lin
- Department of Radiology, Children’s Hospital of Fudan University, Shanghai, China
| | - Qiong Yao
- Department of Radiology, Children’s Hospital of Fudan University, Shanghai, China
| | - Junbo Wang
- Department of Radiology, Children’s Hospital of Fudan University, Shanghai, China
| | - Jian Zhou
- Department of Radiology, Children’s Hospital of Fudan University, Shanghai, China
| | - Lan He
- Heart Centre, Children’s Hospital of Fudan University, Shanghai, China
| | - Gang Chen
- Heart Centre, Children’s Hospital of Fudan University, Shanghai, China
| | - Xihong Hu
- Department of Radiology, Children’s Hospital of Fudan University, Shanghai, China
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Ghumman GM, Khan A, Shafqat M, Shah J, Singh H. A Coronary Cameral Fistula Associated With Incessant Ventricular Arrhythmias. Cureus 2023; 15:e35847. [PMID: 37033551 PMCID: PMC10076682 DOI: 10.7759/cureus.35847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2023] [Indexed: 03/09/2023] Open
Abstract
Coronary cameral fistula (CCF) is a rare congenital abnormality of abnormal communication between coronary arteries and cardiac chambers. Most patients are asymptomatic, while symptomatic patients are usually present in childhood. Adult patients can present with angina, heart failure, or arrhythmias. We report a rare case of CCF with associated recurrent torsade de pointes (TdP) in the absence of ischemic heart disease and electrolyte abnormalities.
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The right coronary artery in the heart of chinchilla (Chinchilla laniger Molina). Vet Res Commun 2022; 47:745-752. [DOI: 10.1007/s11259-022-10035-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 10/30/2022] [Indexed: 11/17/2022]
Abstract
AbstractThe pattern of normal coronary vascularization in a mammalian heart includes the presence of both right and left coronary arteries. According to the literature data, the presence of single major coronary arteries is mainly related to cardiac abnormalities. Previously it has been reported that the right coronary artery is absent in the coronary vascularization of the heart in the chinchilla. Our research was carried out on thirty chinchillas (Chinchilla laniger Molina). The coronary vessels were filled with colored latex to render them visible. The examinations were supplemented additionally with the use of microcomputed tomography with arterial contrast. Our study demonstrates its undoubtedly presence of the right coronary artery. In all subjects the right coronary artery was present, as was the left coronary artery. Two types of right coronary artery were found. Our results indicate that the normal pattern of coronary vascularization of heart in chinchilla includes both the right and left coronary arteries. An open question remains the presence of single coronary artery is a normal pattern of cardiac arterial vascularization in chinchilla.
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Binka E, Zhao N, Wood S, Zimmerman SL, Thompson WR. Exercise-Induced Abnormalities of Regional Myocardial Deformation in Anomalous Aortic Origin of the Right Coronary Artery. World J Pediatr Congenit Heart Surg 2020; 11:712-719. [PMID: 33164683 DOI: 10.1177/2150135120947689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS Congenital coronary artery anomalies are uncommon and may result in sudden death. Management of asymptomatic patients with anomalous aortic origin of the right coronary artery (AAORCA) remains controversial with a lack of evidence to guide decision-making. We hypothesized that patients with AAORCA may have exercise-inducible ischemia detectable as abnormalities in regional myocardial deformation on exercise stress echocardiography (ESE). METHODS We reviewed clinical data, computed tomography angiography, and treadmill ESE from 33 AAORCA patients (21 unoperated, 12 operated) and 11 controls. Regional wall motion on ESE was visually assessed. Doppler tissue imaging was done pre and post exercise to evaluate regional myocardial wall deformation. The post- to pre-exercise time to peak systolic strain corrected for heart rate ratio (TPScR) for the left ventricular inferior and anterior walls of AAORCA patients was compared to controls. RESULTS No regional wall motion abnormalities were noted. The TPScR of the inferior wall was higher in unoperated (0.96 ± 0.41) but not operated (0.84 ± 0.28) AAORCA patients compared to controls (0.76 ± 0.18, P = .03 vs .23, respectively). There was no significant difference in TPScR of the anterior wall between unoperated patients and controls (P = .08). CONCLUSION In some AAORCA patients undergoing ESE, TPScR of the left ventricular inferior wall is elevated, suggestive of ischemia induced by exercise in myocardium supplied by the right coronary artery. Further work is needed to understand the potential role of this finding in risk assessment.
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Affiliation(s)
- Edem Binka
- Division of Pediatric Cardiology, Department of Pediatrics, 1500Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ni Zhao
- Department of Biostatistics, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Scott Wood
- Division of Pediatric Cardiology, 1501Johns Hopkins Hospital, Baltimore, MD, USA
| | - Stefan L Zimmerman
- Department of Radiology and Radiological Sciences, 1500Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - W Reid Thompson
- Division of Pediatric Cardiology, Department of Pediatrics, 1500Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Karangelis D, Mylonas KS, Loggos S, Adreanides E, Tzifa A, Mitropoulos F. Surgical repair of anomalous aortic origin of coronary artery in adults. Asian Cardiovasc Thorac Ann 2020; 29:51-58. [PMID: 32903023 DOI: 10.1177/0218492320957818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Anomalous aortic origin of a coronary artery is a congenital abnormality of the origin or course of a coronary artery that arises from the aorta. The surgical treatment of this anomaly is highly variable and controversial and is achieved by implementing elaborate techniques of anatomic repair or by simple coronary artery bypass grafting. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two independent reviewers determined whether studies met the inclusion criteria. Eligible papers were published in English, clinical studies describing surgical repair of anomalous aortic origin of a coronary artery including coronary artery bypass in adults, and enrolled >5 patients. In the absence of multicentre trials, 7 single-center retrospective series were included, which demonstrated comparable short- and midterm outcomes of anatomic repair and coronary artery bypass in adults with anomalous aortic origin of a coronary artery. Coronary unroofing was the preferred technique when the anomalous artery has an intramural component, but there is a risk of aortic insufficiency. Anatomic repair is technically demanding and should be carried out in experienced centers. Coronary artery bypass with internal thoracic artery or vein grafts is technically straightforward with low operative risk and comparable midterm outcomes, however, long-term outcomes are unknown. Coronary artery bypass grafting is the technique of choice for older patients, in those with concomitant coronary artery disease, as a bailout procedure for failed anatomic repair, or in centers without experience in anatomic repair for anomalous aortic origin of a coronary artery.
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Affiliation(s)
| | | | - Spiros Loggos
- Department of Cardiac Surgery, Mitera Hospital, Athens, Greece
| | - Elias Adreanides
- Department of Cardiology, Medical Institution Military Shareholder Fund, Athens, Greece
| | - Aphrodite Tzifa
- Department of Congenital Cardiology, Mitera Hospital, Athens, Greece
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Affiliation(s)
| | - Gary Randall Green
- Department of Cardiothoracic Surgery SUNY Upstate Medical University Syracuse New York
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Lipshultz SE, Law YM, Asante-Korang A, Austin ED, Dipchand AI, Everitt MD, Hsu DT, Lin KY, Price JF, Wilkinson JD, Colan SD. Cardiomyopathy in Children: Classification and Diagnosis: A Scientific Statement From the American Heart Association. Circulation 2019; 140:e9-e68. [PMID: 31132865 DOI: 10.1161/cir.0000000000000682] [Citation(s) in RCA: 165] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In this scientific statement from the American Heart Association, experts in the field of cardiomyopathy (heart muscle disease) in children address 2 issues: the most current understanding of the causes of cardiomyopathy in children and the optimal approaches to diagnosis cardiomyopathy in children. Cardiomyopathies result in some of the worst pediatric cardiology outcomes; nearly 40% of children who present with symptomatic cardiomyopathy undergo a heart transplantation or die within the first 2 years after diagnosis. The percentage of children with cardiomyopathy who underwent a heart transplantation has not declined over the past 10 years, and cardiomyopathy remains the leading cause of transplantation for children >1 year of age. Studies from the National Heart, Lung, and Blood Institute-funded Pediatric Cardiomyopathy Registry have shown that causes are established in very few children with cardiomyopathy, yet genetic causes are likely to be present in most. The incidence of pediatric cardiomyopathy is ≈1 per 100 000 children. This is comparable to the incidence of such childhood cancers as lymphoma, Wilms tumor, and neuroblastoma. However, the published research and scientific conferences focused on pediatric cardiomyopathy are sparcer than for those cancers. The aim of the statement is to focus on the diagnosis and classification of cardiomyopathy. We anticipate that this report will help shape the future research priorities in this set of diseases to achieve earlier diagnosis, improved clinical outcomes, and better quality of life for these children and their families.
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Jalal Z, Piechaud JF, Villemain O, Sitenfane F, Malekzadeh-Milani S, Boudjemline Y. Percutaneous coronary artery interventions in the paediatric population: Periprocedural and late outcome. Arch Cardiovasc Dis 2018; 111:644-655. [DOI: 10.1016/j.acvd.2017.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 06/22/2017] [Accepted: 08/27/2017] [Indexed: 11/26/2022]
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Buccheri D, Chirco PR, Geraci S, Caramanno G, Cortese B. Coronary Artery Fistulae: Anatomy, Diagnosis and Management Strategies. Heart Lung Circ 2018; 27:940-951. [PMID: 29503240 DOI: 10.1016/j.hlc.2017.07.014] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 04/03/2017] [Accepted: 07/10/2017] [Indexed: 12/27/2022]
Abstract
Coronary artery fistula (CAF) is a relatively rare anatomic abnormality of the coronary arteries that afflicts 0.002% of the general population and represents 14% of all the anomalies of coronary arteries. Its clinical relevance focusses mainly on the mechanism of "coronary steal phenomenon", causing myocardial functional ischaemia even in the absence of stenosis, hence common symptoms are angina or effort dyspnoea. The suggested diagnostic approach is guided by the patient's symptoms and consists of a number of instrumental examinations like ECG, treadmill test, echocardiography, computed tomography scan, cardiac magnetic resonance and coronary angiography. If it is not an incidental finding, coronary angiography is required in view of the optimal therapeutic planning. Small-sized fistulae are usually asymptomatic and have an excellent prognosis if managed medically with clinical follow-up with echocardiography every 2 to 5 years. In the case of symptomatic, large-sized or giant fistulae an invasive treatment, by transcatheter approach or surgical ligation, is usually a reasonable choice, and both strategies show equivalent results at long-term follow-up. Antibiotic prophylaxis for the prevention of bacterial endocarditis is recommended in all patients with coronary artery fistulae who undergo dental, gastrointestinal or urological procedures. A life-long follow-up is always essential to ensure that the patient is not undergoing progression of disease or further cardiac complications.
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Affiliation(s)
- Dario Buccheri
- Interventional Cardiology, San Giovanni di Dio Hospital, Agrigento, Italy.
| | - Paola Rosa Chirco
- Emergency Department, Paolo Giaccone University Hospital, Palermo, Italy
| | - Salvatore Geraci
- Interventional Cardiology, San Giovanni di Dio Hospital, Agrigento, Italy
| | - Giuseppe Caramanno
- Interventional Cardiology, San Giovanni di Dio Hospital, Agrigento, Italy
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12
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Mavroudis C. Coronary artery bypass grafting in infants, children, and young adults for acquired and congenital lesions. CONGENIT HEART DIS 2017; 12:644-646. [DOI: 10.1111/chd.12491] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 05/20/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Constantine Mavroudis
- Johns Hopkins University School of Medicine, Florida Hospital for Children; Orlando Florida
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13
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Rodriguez JD. Incidental Finding of a Right Coronary Artery to Coronary Sinus Fistula in an Adult Transthoracic Echocardiogram. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2016. [DOI: 10.1177/8756479316664339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Congenital coronary artery fistula (CAF) is a rare anomaly of the heart presenting in 0.002% of the general population. This case study presents an adult patient with an undiagnosed heart murmur and symptoms of chest pain, fatigue, and lightheadedness that demonstrated an incidental finding of CAF diagnosed by transthoracic echocardiography. Transthoracic echocardiography revealed an aneurysmal, tortuous right coronary artery terminating in a dilated coronary sinus. Sonographic findings were compared with angiography and computed tomography. This study highlights the potential of transthoracic echocardiography to assess heart structure and physiology and detect a CAF.
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Li RJ, Sun Z, Yang J, Yang Y, Li YJ, Leng ZT, Liu GW, Pu LH. Diagnostic Value of Transthoracic Echocardiography in Patients With Anomalous Origin of the Left Coronary Artery From the Pulmonary Artery. Medicine (Baltimore) 2016; 95:e3401. [PMID: 27082616 PMCID: PMC4839860 DOI: 10.1097/md.0000000000003401] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital coronary abnormality associated with early infant mortality and sudden death in adults. Transthoracic echocardiography (TTE) plays an important role in early detection and diagnosis of ALCAPA as a noninvasive modality. However, its diagnostic value is not well studied. The purpose of this study is to determine the performance of TTE in the diagnostic assessment of ALCAPA as compared with coronary CT and invasive coronary angiography. A total of 22 patients (13 women and 9 men, mean age, 12.9 ± 19.5 years) with ALCAPA who underwent echocardiographic examination for clinical diagnosis were retrospectively reviewed and analyzed. Transthoracic echocardiographic features of ALCAPA were analyzed and its diagnostic value was compared with invasive coronary angiography and coronary CT angiography (CTA) with surgical findings serving as the gold standard. Surgery was performed in all of the patients to establish the dual coronary artery system. Five underwent the Takeuchi procedure and 17 had re-implantation of the anomalous left coronary artery. Of 20 patients, echocardiographic diagnoses were in good agreement with findings at surgery, resulting in the diagnostic accuracy of 90.9%. Two cases were misdiagnosed-one as the right coronary artery to pulmonary artery fistula and the other as rheumatic heart disease. The echocardiographic features of these patients with ALCAPA included: abnormal left coronary ostium arising from the pulmonary trunk with retrograde coronary artery flow in 20 patients; enlargement of the right coronary artery in 17 patients; abundant intercoronary septal collaterals in 17 patients; and moderate and significant mitral regurgitation in 14 patients. The diagnostic accuracy of invasive coronary angiography (in 17 patients) and coronary CTA (in 9 patients) was 100%. This study shows that TTE is an accurate, noninvasive imaging modality for displaying the origin of coronary arteries and demonstrating the coronary courses as well as other associated abnormalities in patients with ALCAPA.
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Affiliation(s)
- Rong-Juan Li
- From the Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (R-JL, JY, YY, Y-JL, Z-TL, G-WL, L-HP); and Department of Medical Radiation Sciences, Curtin University, Perth, Australia (ZS)
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Refatllari A, Likaj E, Dumani S, Hasimi E, Goda A. Surgical Treatment of Anomalous Origin of Right Coronary Artery in a Patient with Mitral Stenosis. Open Access Maced J Med Sci 2016; 4:131-4. [PMID: 27275346 PMCID: PMC4884233 DOI: 10.3889/oamjms.2016.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Revised: 12/06/2015] [Accepted: 12/07/2015] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND An anomalous origin of the right coronary artery is rarely observed, with a reported incidence between 0.026% and 0.25%. This condition is often completely asymptomatic and is found incidentally during angiographic evaluation for other cardiac diseases. However some patients present with exertion angina or sudden death. Surgical treatment in patients with anomalous RCA is still controversial. Treatment can be conservative, angioplasty or surgery. CASE PRESENTATION A 59-year-old man was admitted with severe mitral stenosis. He complained exertion and rest dyspnea, NYHA III class. He had sequels of embolic stroke, results of left atrial thrombus. Echocardiography showed calcified severe mitral stenosis with mitral orifice area of 1.1 square centimeters with PSPAP 60 mmHg and normal LV function. Routine coronary angiography before surgery showed aberrant origin of RCA from the left sinus of Valsalva with 90% stenosis at his origin. Multi-slice computed tomography proved the diagnosis of anomalous RCA arising from the left sinus of Valsalva and taking an inter-arterial course between the aorta and pulmonary artery. The patient underwent mitral valve replacement with mechanical St. Jude prosthesis No 29 and saphenous vein graft to RCA. We chose by-pass grafting techniques because after aortotomy, RCA was too close to LMCA, intramural course was too short and stenosis of RCA was outside of aortic wall. The patient's perioperative course was without complications and patient was discharged on the seventh postoperative day. CONCLUSION Correction of anomalous of the origin of right coronary artery is mandatory in cases where patient has to be operated for other cardiac causes.
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Affiliation(s)
- Ali Refatllari
- Department of Cardiovascular Surgery, University Hospital Centre "Mother Theresa", Rruga e Dibres, N. 370, Tirana, Albania
| | - Ermal Likaj
- Department of Cardiovascular Surgery, University Hospital Centre "Mother Theresa", Rruga e Dibres, N. 370, Tirana, Albania
| | - Selman Dumani
- Department of Cardiovascular Surgery, University Hospital Centre "Mother Theresa", Rruga e Dibres, N. 370, Tirana, Albania
| | - Endri Hasimi
- Department of Cardiovascular Surgery, University Hospital Centre "Mother Theresa", Rruga e Dibres, N. 370, Tirana, Albania
| | - Artan Goda
- Department of Cardiovascular Surgery, University Hospital Centre "Mother Theresa", Rruga e Dibres, N. 370, Tirana, Albania
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Statile C, Statile A, Brown J, Hanke S, Taylor M, Michelfelder E. Using Improvement Methodology to Optimize Echocardiographic Imaging of Coronary Arteries in Children. J Am Soc Echocardiogr 2016; 29:247-52. [DOI: 10.1016/j.echo.2015.08.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Indexed: 10/22/2022]
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17
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Rodriguez-Gonzalez M, Tirado AM, Hosseinpour R, de Soto JS. Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery: Diagnoses and Surgical Results in 12 Pediatric Patients. Tex Heart Inst J 2015; 42:350-6. [PMID: 26413018 DOI: 10.14503/thij-13-3849] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital condition. It responds well to early diagnosis and treatment, but otherwise the prognosis is poor. We present our case series of 12 patients (mean age, 2 ± 2.58 yr; age range, 2 mo-8 yr), emphasizing the diagnostic process and discussing our surgical results. The diagnosis of ALCAPA should be suspected in infants who have dilated cardiomyopathy with electrocardiographic changes that suggest ischemia, and in older children who have isolated mitral regurgitation. When clinical suspicion is high, the results of 2-dimensional echocardiography combined with color-flow Doppler studies in expert hands can establish the diagnosis, thus avoiding angiography in critically ill infants. The treatment of choice in our patients was transfer and reimplantation of the left coronary artery onto the ascending aorta. There were 2 deaths: both were infants in extremis who underwent emergency surgery. An older child with severe ventricular dysfunction was given mechanical ventricular assistance and then heart transplantation. As of this report, all 10 survivors remained well and asymptomatic.
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Ugalde I. Exertional Syncope and a Congenital Cardiac Anomaly. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2014. [DOI: 10.1016/j.cpem.2014.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Coronary Artery Anomalies: Current Recognition and Treatment Strategies. Update on Recent Progress. CURRENT CARDIOVASCULAR RISK REPORTS 2014. [DOI: 10.1007/s12170-014-0395-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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20
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Challoumas D, Pericleous A, Dimitrakaki IA, Danelatos C, Dimitrakakis G. Coronary arteriovenous fistulae: a review. Int J Angiol 2014; 23:1-10. [PMID: 24940026 DOI: 10.1055/s-0033-1349162] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Coronary arteriovenous fistulae are a coronary anomaly, presenting in 0.002% of the general population. Their etiology can be congenital or acquired. We present a review of recent literature related to their epidemiology, etiology, pathophysiology, clinical presentation, diagnostic approach, and therapeutic management.
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Affiliation(s)
- Dimitris Challoumas
- School of Medicine, Cardiff University, Heath Park Campus, Cardiff, United Kingdom
| | - Agamemnon Pericleous
- School of Medicine, Cardiff University, Heath Park Campus, Cardiff, United Kingdom
| | | | | | - Georgios Dimitrakakis
- Department of Cardiothoracic Surgery, University Hospital of Wales, Cardiff, United Kingdom
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Jatene M, Juaneda I, Miranda RDA, Gato R, Marcial MLB. Left main coronary artery atresia and associated cardiac defects: report on concomitant surgical treatment. World J Pediatr Congenit Heart Surg 2013; 2:656-9. [PMID: 23804483 DOI: 10.1177/2150135111414437] [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] [Indexed: 11/16/2022]
Abstract
A 9-year-old boy with congenital atresia of the left main coronary artery underwent myocardial revascularization. Coarctation of the aorta and ventricular septal defect were diagnosed at the age of 1 year. At age 7 years, the child presented with syncope while exercising. Preoperative evaluation included cardiac catheterization which revealed the unexpected finding of congenital atresia of the left main coronary artery with origin of the circumflex artery from the right coronary artery. Surgical correction included myocardial revascularization by means of left internal mammary artery graft to the anterior descending coronary artery, coarctation resection, and ventricular septal defect repair. The patient recovered uneventfully. We report the details of this extremely rare case with successful concomitant surgical management of the congenital coronary artery anomaly and the associated structural heart disease.
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Affiliation(s)
- Marcelo Jatene
- Heart Institute, University of São Paulo, São Paulo, Brazil
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22
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Torigoe T, Sato S, Kikuchi C, Kanazawa H. Anomalous origin of the left coronary artery from the proper sinus with acute angulation and an intramural segment. CONGENIT HEART DIS 2013; 9:E1-5. [PMID: 23448495 DOI: 10.1111/chd.12045] [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] [Accepted: 12/26/2012] [Indexed: 11/26/2022]
Abstract
This is the first report of a coronary artery with an anomalous origin from the proper sinus resulting in ischemic events in a child. Transthoracic echocardiogram, computed tomogram, and coronary angiogram revealed that, although the left main coronary trunk originated from the left sinus, its ostium was displaced horizontally and was located near the commissure between the left and noncoronary valve cusps. Moreover, it was associated with an acute take off angle and an intramural segment, which are known contributing features for ischemia in cases of anomalous origin of a coronary artery from the wrong sinus. Surgical intervention, involving the unroofing procedure, was employed successfully to eliminate the ischemic events. At the latest follow up, no chest pain was reported and the transthoracic echocardiogram showed no stenosis of the neo-ostium. Even in a coronary artery that originates from the proper sinus, an abnormal ostial location could be associated with an acute takeoff angle and an intramural segment. This finding is extremely rare but entails the risk of ischemia and sudden death.
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Affiliation(s)
- Tsukasa Torigoe
- Department of Pediatrics, Niigata City General Hospital, Niigata, Japan
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Peñalver JM, Mosca RS, Weitz D, Phoon CKL. Anomalous aortic origin of coronary arteries from the opposite sinus: a critical appraisal of risk. BMC Cardiovasc Disord 2012; 12:83. [PMID: 23025810 PMCID: PMC3502461 DOI: 10.1186/1471-2261-12-83] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 08/27/2012] [Indexed: 01/31/2023] Open
Abstract
Background Anomalous aortic origin of the coronary artery (AAOCA) from the opposite sinus of Valsalva with an interarterial course has received much attention due to its association with sudden death in otherwise healthy individuals. AAOCA is relatively common and may have significant public health implications. While our knowledge of its pathophysiology and natural history remains incomplete, an emphasis has been placed on surgical correction. Discussion In 2005 we published a review examining the rates of sudden death with AAOCA, as well as complications of surgical management. Evidence now points even more strongly to lower rates of sudden death, while surgical outcomes data now better documents associated risks. Summary Armed with this updated information, we agree with the need for a national registry to better track patients with AAOCA. We submit that the risks of surgical management outweigh any benefits in the asymptomatic patient with anomalous right coronary artery, and expectant management should also be strongly considered even in asymptomatic patients with anomalous left coronary artery.
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Affiliation(s)
- Josiah M Peñalver
- Division of Pediatric Cardiology, Department of Pediatrics, 160 East 32nd Street, L-3, New York, NY 10016, USA.
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24
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Ergul Y, Nisli K, Aydogan U. A rare cause of cardiac syncope mimicking epilepsy: left main coronary artery stenosis. Pediatr Int 2011; 53:581-3. [PMID: 21851492 DOI: 10.1111/j.1442-200x.2010.03254.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Yakup Ergul
- Department of Pediatric Cardiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
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25
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Morgan G, Caldarone C, Anderson R, Chaturvedi R. Anomalous origin of the left coronary artery from the right pulmonary artery presenting following relief of left heart obstruction: a distinct and predictable clinico-pathological syndrome. CONGENIT HEART DIS 2010; 5:327-30. [PMID: 20576056 DOI: 10.1111/j.1747-0803.2009.00357.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Pre-operative recognition of significant abnormalities of the coronary arteries is important in a variety of congenital cardiac conditions. Failure to diagnose anomalous origin of the coronary artery from the pulmonary artery during repair of other anomalies is important because reduction in pulmonary artery pressure will reduce myocardial perfusion pressure. PATIENTS We report two cases of the rare association of anomalous origin of the left coronary artery from the right pulmonary artery, aortic coarctation, and mitral stenosis. CONCLUSIONS Definitive imaging of coronary artery anatomy by echocardiography or other modalities should form a routine part of diagnostic assessment in all congenital heart disease patients but particularly those with left heart obstruction.
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Affiliation(s)
- Gareth Morgan
- Hospital for Sick Children--Labatt Family Heart Centre, Toronto Canada.
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26
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Oxygen Supplementation Is Helpful for the Echocardiographic Detection of Anomalous Left Coronary Artery from the Pulmonary Artery. J Am Soc Echocardiogr 2010; 23:1099-102. [DOI: 10.1016/j.echo.2010.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Indexed: 11/22/2022]
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Mavroudis C, Dodge-Khatami A, Stewart RD, Jacobs ML, Backer CL, Lorber RE. An overview of surgery options for congenital coronary artery anomalies. Future Cardiol 2010; 6:627-45. [DOI: 10.2217/fca.10.82] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Congenital and acquired coronary artery anomalies are associated with significant morbidity and mortality and can be sudden in onset. The spectrum of congenital lesions include anomalous origin from the pulmonary artery, critical left main stenosis/atresia, coronary artery fistulas, anomalous aortic origin and intramyocardial courses. The spectrum of acquired lesions include Kawasaki disease, late postoperative obstructions in patients who had coronary artery surgical manipulations and iatrogenic injuries that can occur in the catheterization laboratory or the operating room. Surgical therapies for ischemic syndromes associated over the long term of these anomalies are presented herein.
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Affiliation(s)
| | - Ali Dodge-Khatami
- Department of Pediatric Cardiac Surgery, University Heart Center Hamburg-Eppendorf University of Hamburg-Eppendorf School of Medicine, Martinistrasse 52, 20246 Hamburg, Germany
| | - Robert D Stewart
- Center for Pediatric & Adult Congenital Heart Diseases, Cleveland Clinic Children’s Hospital, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Marshall L Jacobs
- Center for Pediatric & Adult Congenital Heart Diseases, Cleveland Clinic Children’s Hospital, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Carl L Backer
- Division of Pediatric Cardiovascular-Thoracic Surgery, Department of Surgery, Children’s Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Richard E Lorber
- Center for Pediatric & Adult Congenital Heart Diseases, Cleveland Clinic Children’s Hospital, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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Pyles LA, Berry JM, Steinberger J, Foker JE. Initial, intra-operative, and post-operative evaluation of children with pulmonary atresia with intact ventricular septum with emphasis on the coronary connections to the right ventricle. PROGRESS IN PEDIATRIC CARDIOLOGY 2010. [DOI: 10.1016/j.ppedcard.2010.02.007] [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] [Indexed: 11/30/2022]
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29
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Caldarone CA, Williams WG. The Congenital Heart Surgeons Society Datacenter: unique attributes as a research organization. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2010; 13:71-75. [PMID: 20307865 DOI: 10.1053/j.pcsu.2010.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Over the last 25 years, the Congenital Heart Surgeons Society (CHSS) has evolved from an informal club to a mature organization. A central feature of the CHSS has been dedication to evaluating outcomes of congenital heart surgery across a wide array of clinical diagnoses. These research activities have been orchestrated through the CHSS Datacenter, which has developed a unique organizational structure that has strengths and weaknesses in comparison to other research organizational structures (e.g., prospective randomized trials, registries, etc). This review will highlight the unique attributes of the CHSS Datacenter with emphasis on the Datacenter's strengths and weaknesses in comparison to other organizational structures.
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Affiliation(s)
- Christopher A Caldarone
- Division of Cardiovascular Surgery, University of Toronto, Hospital for Sick Children, 555 University Ave., Toronto, Ontario, Canada.
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30
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Baik R, Kim NK, Park HK, Park YH, Yoo BW, Choi JY. Anomalous origin of left coronary artery arising from the right coronary cusp presenting with chest discomfort and syncope on physical exercise. KOREAN JOURNAL OF PEDIATRICS 2010. [DOI: 10.3345/kjp.2010.53.2.248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Ran Baik
- Division of Pediatric Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Nam Kyun Kim
- Division of Pediatric Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Han Ki Park
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Young Hwan Park
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Byung Won Yoo
- Division of Pediatric Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Jae Young Choi
- Division of Pediatric Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
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Kayalar N, Burkhart HM, Dearani JA, Cetta F, Schaff HV. Congenital coronary anomalies and surgical treatment. CONGENIT HEART DIS 2009; 4:239-51. [PMID: 19664026 DOI: 10.1111/j.1747-0803.2009.00301.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Coronary artery anomalies are not uncommon, occurring in 1.3% (range = 0.3-5.6%) of the population, and are often an incidental finding in asymptomatic patients. Approximately 20% of coronary anomalies have potential for life-threatening complication, including myocardial infarction, arrhythmia, or sudden death early in life or during adulthood. Coronary artery anomalies are composed of a wide variety of disorders. Some, such as anomalous location of a coronary ostium, duplication of coronary arteries, or multiple ostia, become clinically significant only when another cardiac surgical procedure is necessary, and generally, surgical correction is not required in these patients. On the other hand, the diagnosis of anomalous origin of left coronary artery from pulmonary artery or from the opposite sinus with inter-arterial course is an indication for operation. Some anomalies like coronary artery fistulas, myocardial bridging, and coronary aneurysm require operation only when they cause clinical symptoms. Coronary artery anomalies should be included in the differential diagnosis of anginal symptoms, myocardial infarction, arrhythmia, or heart failure, especially in young patients. Increased awareness of these pathologies will lead to earlier diagnosis and treatment of a potentially life-threatening condition.
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Affiliation(s)
- Nihan Kayalar
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn 55905, USA
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32
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Loukas M, Groat C, Khangura R, Owens DG, Anderson RH. The normal and abnormal anatomy of the coronary arteries. Clin Anat 2009; 22:114-28. [PMID: 19097062 DOI: 10.1002/ca.20761] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Beneficial therapeutic options are increasingly available for coronary arterial disease. To take full advantage of these options, those performing the interventions require a thorough knowledge of the normal arrangement, and likely anatomic variations, of the coronary arterial system. A comprehensive appreciation of the architecture of the coronary arterial system, therefore, is crucial to optimal cardiac care. Simple attention to potential variations in the origin and course of the major coronary arteries can greatly enhance clinical outcomes. The objective of this review, therefore, is to describe the normal anatomical distribution of the coronary arteries in the human heart, and to list the most common arterial variations.
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Affiliation(s)
- Marios Loukas
- Department of Anatomical Sciences, School of Medicine, St. George's University, Grenada, West Indies.
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