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Cai R, Xu J, Yan C, Wang J, Wang LI, Ku L, Zhou D, Zhu LI, He C, Zhao X, Ma X. Imaging characteristics and ECG distribution of coronary fistulas: The first large-scale study. Clin Imaging 2024; 105:110016. [PMID: 38039748 DOI: 10.1016/j.clinimag.2023.110016] [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] [Received: 05/05/2023] [Revised: 10/24/2023] [Accepted: 10/30/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND The proportion of abnormal electrocardiogra (ECG) in patients with coronary artery fistula (CAF) is relatively high, but the correlation between CAF and arrhythmia is mostly reported in individual case studies. This paper analyzes the correlation between imaging features and ECG features. OBJECTIVE This paper aims to analyze the incidence and distribution characteristics of abnormal ECG in patients with CAF and further explore the difference in ECG characteristics between coronary-cameral fistula (CCF) and coronary-pulmonary artery fistula (CPAF). METHOD A total of 144,448 patients who underwent coronary computerized tomography angiography (CTA) examination from January 2016 to December 2022 were included in this study, and 284 patients with CAF (excluding coronary atherosclerosis) were selected for analysis of their ECG and image characteristics. And divided them into the CPAF (221 cases) and CCF (63 cases) groups, the differences in ECG between the two groups was compared. The changes in the ECG after the operation were analyzed. RESULTS The incidence of abnormal ECG in patients with CAF was approximately 72.9%. There were significant differences in the proportion of ECG block, myocardial ischemia and structural ECG changes between the CPAF group and CCF group (P < 0.05). CCF was more likely to cause conduction block and ischemic and structural ECG changes. A total of 53 patients with CAF underwent surgical treatment, 28 patients with improved ECG (52%). CONCLUSION CCF especially CCF patients often have abnormal ECG findings such as conduction block, myocardial ischemia, and structural changes, which can often be restored to normal through surgery.
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Affiliation(s)
- Renhui Cai
- Department of Radiology, Asia Heart Hospital, No.753 Jinghan Road, Hankou District, Wuhan 430022, PR China
| | - Juan Xu
- Department of Radiology, Asia Heart Hospital, No.753 Jinghan Road, Hankou District, Wuhan 430022, PR China
| | - Chaoqun Yan
- Department of Radiology, Asia Heart Hospital, Wuhan 430022, PR China
| | - Jie Wang
- Department of Radiology, Asia Heart Hospital, Wuhan 430022, PR China
| | - L I Wang
- Department of Radiology, Asia Heart Hospital, Wuhan 430022, PR China
| | - Leizhi Ku
- Department of Radiology, Asia Heart Hospital, Wuhan 430022, PR China
| | - Di Zhou
- Department of Radiology, Asia Heart Hospital, Wuhan 430022, PR China
| | - L I Zhu
- Department of Radiology, Asia Heart Hospital, Wuhan 430022, PR China
| | - Chunli He
- Department of Radiology, Asia Heart Hospital, Wuhan 430022, PR China
| | - Xinxiang Zhao
- Department of Radiology, The Second Affifiliated Hospital of Kunming Medical University, PR China.
| | - Xiaojing Ma
- Department of Echocardiography, Asia Heart Hospital, Wuhan 430022, PR China.
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Fanai V, Malviya A, Mishra A, Lynser D, Ete T. Giant Coronary Aneurysm Causing Ostial Occlusion of Coronary Artery by Mass Effect: A Case Report. Cureus 2021; 13:e16280. [PMID: 34377613 PMCID: PMC8349522 DOI: 10.7759/cureus.16280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2021] [Indexed: 11/05/2022] Open
Abstract
Coronary atherosclerosis can rarely lead to complications like giant coronary aneurysm (GCA), and acute myocardial infarction (AMI) due to thrombosis in the GCA is even rarer. Multimodality imaging is preferred over relying solely on selective coronary angiogram in such cases due to the limitations of invasive coronary angiogram in visualizing thrombosed aneurysms. We report a rare case of a patient with ST-elevation myocardial infarction caused by ostial occlusion of a right coronary artery (RCA) due to mass effect created by thrombosis in a GCA, thereby highlighting a mechanism of AMI that has not been previously described in GCA. Multimodality imaging led to the correct diagnosis and detection of the underlying mechanism, which had been completely missed by invasive coronary angiography (ICA). We also discuss the utility of multimodality imaging in such cases.
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Affiliation(s)
| | - Amit Malviya
- Cardiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
| | - Animesh Mishra
- Cardiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
| | - Donboklang Lynser
- Radiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
| | - Tony Ete
- Cardiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
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Battisha A, Madoukh B, Sheikh O, Altibi A, Sheikh S, Al-Sadawi M. Coronary Fistula Between Left Anterior Descending Artery (LAD) and Pulmonary Artery (PA) Leading to Sudden Cardiac Death: Case Report with Literature Review. Curr Cardiol Rev 2020; 16:98-102. [PMID: 31593531 PMCID: PMC7460707 DOI: 10.2174/1573403x15666191008100848] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 08/14/2019] [Accepted: 08/27/2019] [Indexed: 11/22/2022] Open
Abstract
Coronary Artery Fistulas (CAF) are inappropriate connections between a coronary artery and a major vessel or a cardiac chamber. These fistulas may or may not present with symptoms, but they need to be detected as early as possible in order to decide the most appropriate treatment methodology (i.e. surgery vs. conservative management). We report the case of a 67-year-old female with no modifiable cardiovascular risk factors who had an unwitnessed sudden death at home during her ongoing evaluation of a fistula detected incidentally between the Left Anterior Descending Artery (LAD) and the Pulmonary Artery (PA). This case highlights that early diagnosis and treatment of symptomatic CAF are crucial to minimize the risk of sudden cardiac death. Although the symptomatic fistula of LAD to PA has been reported in the literature multiple times, it has been rarely reported that this fistula can result in sudden cardiac death.
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Affiliation(s)
- Ayman Battisha
- Department of Internal Medicine, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts, MA 01003, United States
| | - Bader Madoukh
- Department of Internal Medicine, Overland Park Regional Medical Center-HCA Midwest Health, Overland Park, Kansas, KS, United States
| | - Omar Sheikh
- Department of Internal Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 77030, United States
| | - Ahmed Altibi
- Department of Internal Medicine, Henry Ford Allegiance Health, Jackson, MI, United States
| | - Shakil Sheikh
- Department of Cardiology, State University of New York, Downstate Medical Center, Brooklyn, New York, NY 12222, United States
| | - Mohammed Al-Sadawi
- Department of Internal Medicine, State University of New York, Downstate Medical Center, Brooklyn, New York, NY 12222, United States
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Pham V, Hemptinne QD, Grinda JM, Duboc D, Varenne O, Picard F. Giant coronary aneurysms, from diagnosis to treatment: A literature review. Arch Cardiovasc Dis 2020; 113:59-69. [DOI: 10.1016/j.acvd.2019.10.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 10/17/2019] [Accepted: 10/23/2019] [Indexed: 12/26/2022]
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Liu J, Wang X, Sun D, Yang J. Dual Aneurysms of the Left Anterior Descending Coronary Artery Initially Detected by Echocardiography. Int Heart J 2019; 60:778-783. [PMID: 31019166 DOI: 10.1536/ihj.18-401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Echocardiographic detection of abnormalities occurring medially and distally in coronary arteries is uncommon and is not well recognized. Herein, we describe an 87-year-old woman with two distinct aneurysms involving a branch of the left anterior descending coronary artery (LAD), one of which communicated with the pulmonary artery (PA). Initially determined via transthoracic echocardiography (TTE), these findings were subsequently validated by coronary computed tomography angiography (CTA). We also present a review of the published studies of multiple coronary artery aneurysms (CAAs) exceeding 20 mm in diameter, focusing on the location, etiology, symptoms, and common ultrasonic characteristics of 30 cases. Echocardiography is a valuable, noninvasive technique for initial detection, monitoring, and follow-up of CAAs, serving to direct further diagnostics.
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Affiliation(s)
- Juanjuan Liu
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University
| | - Xiaobing Wang
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University
| | - Dandan Sun
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University
| | - Jun Yang
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University
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Tahir H, Kennedy T, Awan MU, Omar B, Malozzi C, Awan GM. Left Main Coronary Artery Diverticulum: Case Report and Review of the Literature. Cardiol Res 2018; 9:186-190. [PMID: 29904458 PMCID: PMC5997441 DOI: 10.14740/cr714w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 03/29/2018] [Indexed: 12/28/2022] Open
Abstract
Coronary artery disease is a major cause of morbidity and mortality, and while most commonly is atherosclerotic, it can present with variable manifestations, both congenital and acquired. One such manifestation is coronary aneurysm, which is a localized dilatation of a coronary artery wall segment to greater than 1.5 times the adjacent normal segments. While a dilated outpouching of a coronary artery has been commonly classified as a coronary aneurysm, a non-dilated outpouching is rare and is referred to as a diverticulum, with only one previous case report in the literature. It is conceivable that other cases of coronary artery diverticulum may have been previously reported as an aneurysm, given the overlapping angiographic appearance. We present a case of a 72-year-old female patient with an incidental finding of left main coronary artery diverticulum on diagnostic coronary angiogram done for preoperative liver transplantation evaluation.
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Affiliation(s)
- Hassan Tahir
- Division of Cardiology, University of South Alabama, Mobile, AL, USA
| | - Timothy Kennedy
- Division of Cardiology, University of South Alabama, Mobile, AL, USA
| | - M Umer Awan
- Division of Cardiology, University of South Alabama, Mobile, AL, USA
| | - Bassam Omar
- Division of Cardiology, University of South Alabama, Mobile, AL, USA
| | | | - G Mustafa Awan
- Division of Cardiology, University of South Alabama, Mobile, AL, USA
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Said SAM. Congenital coronary artery fistulas complicated with pulmonary hypertension: Analysis of 211 cases. World J Cardiol 2016; 8:596-605. [PMID: 27847561 PMCID: PMC5088366 DOI: 10.4330/wjc.v8.i10.596] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 03/26/2016] [Accepted: 08/08/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To compare the behavior of pulmonary hypertension (PHT) associated with coronary artery fistulas (CAFs) between the Asian and Caucasian subjects.
METHODS CAFs may be complicated with PHT secondary to left-to-right shunt. Literature review limited to the English language. A total of 211 reviewed patients were collected. Of those, 111 were of Asian and 100 were of Caucasian ethnic origin. The mean age of the Asian and the Caucasian groups of patients were 48.9 (range 19-83) and 49.9 years (range 16-85), respectively. In both groups, right heart catheterization was the most commonly (95%) used method for determining pulmonary artery pressure.
RESULTS From all of the reviewed subjects, PHT was found in 49 patients (23%), of which 15 were Asian and 34 were Caucasian. In 75% of PHT subjects, mild to moderate PHT was reported and 76% of the fistulas had a vascular mode of termination. Treatment was surgical in 61%, followed by percutaneous therapeutic embolization (27%) and finally conservative medical management in 12% of PHT subjects. PHT was associated with a slight female gender predominance. The majority demonstrated mild to moderate PHT. PHT was reported more frequent in the Caucasian compared with the Asian ethnicity group. The majority of fistulas in patients with PHT had a vascular mode of termination. The results of this review are intended to be indicative and require cautious interpretation.
CONCLUSION The likelihood for a CAF patient to develop PHT is presented when possessing the following features, with a Caucasian female having a fistula with a vascular mode of termination.
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Wang L, Wang J, Cheng TO, Xie M, Wang X, Song Y, Liu J, Wei F. Giant left coronary artery aneurysms: Review of the literature and report of a rare case diagnosed by transthoracic echocardiography. Int J Cardiol 2015; 189:267-71. [DOI: 10.1016/j.ijcard.2015.04.082] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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