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Bowles J, Martin J, Russell PL, Bailey A, Holland DJ. Coronary artery fistula following surgical myectomy for hypertrophic obstructive cardiomyopathy: a case report. Eur Heart J Case Rep 2024; 8:ytae248. [PMID: 38845810 PMCID: PMC11156195 DOI: 10.1093/ehjcr/ytae248] [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] [Received: 02/22/2024] [Revised: 05/06/2024] [Accepted: 05/13/2024] [Indexed: 06/09/2024]
Abstract
Background Coronary artery fistula is a rare, but recognized complication of surgical myectomy. Although most communicate with the right heart, a large fistula into the left ventricular cavity may result in a shunt haemodynamically analogous to aortic regurgitation. Understanding the variable presentation of iatrogenic coronary fistulae and the optimal evaluation strategy is critical to obtaining a timely diagnosis and instituting treatment. Case summary We report the case of a 57-year-old renal transplant recipient admitted for evaluation of presyncope, one-year post-surgical myectomy for hypertrophic obstructive cardiomyopathy. An iatrogenic coronary artery fistula was suspected by transthoracic echocardiography, and later confirmed with both non-invasive and invasive coronary angiography. Discussion We highlight various cardiac imaging modalities that confirmed the diagnosis of coronary artery fistula and helped to determine the clinical significance. We report the tailored approach often required to determine the anatomic and haemodynamic characteristics of coronary fistulae and outline potential management strategies.
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Affiliation(s)
- James Bowles
- Department of Cardiology, Sunshine Coast University Hospital, 6 Doherty Street, Birtinya, 4575 Queensland, Australia
| | - Joshua Martin
- Department of Cardiology, Sunshine Coast University Hospital, 6 Doherty Street, Birtinya, 4575 Queensland, Australia
| | - Penni L Russell
- Department of Cardiology, Sunshine Coast University Hospital, 6 Doherty Street, Birtinya, 4575 Queensland, Australia
| | - Amy Bailey
- Department of Cardiology, Sunshine Coast University Hospital, 6 Doherty Street, Birtinya, 4575 Queensland, Australia
| | - David J Holland
- Department of Cardiology, Sunshine Coast University Hospital, 6 Doherty Street, Birtinya, 4575 Queensland, Australia
- School of Medicine and Dentistry, Griffith University, 6 Doherty Street, Birtinya, 4575 Queensland, Australia
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, 4072 Queensland, Australia
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Mi C, Zhang X, Wang L, Yun Y, Li F, Li Y, Liu Y, Zhang S, Zou C, Zhang H, Ma X. Coronary pseudoaneurysm with a superficial mass and accompanying Brucella infection. J Cardiothorac Surg 2024; 19:63. [PMID: 38321525 PMCID: PMC10845731 DOI: 10.1186/s13019-024-02537-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 01/28/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND AND AIMS To our knowledge, no previously reported clinical data of a coronary artery fistula forming a pseudoaneurysm and presenting as a anterior chest wall lump. We reported a rare case of Coronary pseudoaneurysm with a superficial mass and accompanying Brucella infection. The patient was successfully treated with surgery. MATERIALS AND METHODS The patient case data was extracted from hospital records. RESULTS A 64-year-old male presented with a history of paroxysmal left-sided chest pain and painful anterior chest wall lump. Coronary computed tomography (CT) angiography revealed the RCA pseudoaneurysm that showed a peripherally calcified soft-tissue mass in the anterior mediastinum and communicated with the chest wall lump through intercostal spaces. The patient underwent the resection of chest lump and RCA pseudoaneurysm under cardiopulmonary bypass, along with a combined antimicrobial therapy. The patient was discharged successfully after the surgery. DISCUSSION AND CONCLUSION We report this rare case and highlight the possible origin of the anterior mediastinal mass and anterior chest wall lump as a pseudoaneurysm formed by a coronary artery fistula.
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Affiliation(s)
- Chuanxiao Mi
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No. 324, Jingwu Road, Jinan, Shandong, 250021, China
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong University, Jinan, Shandong, 250021, China
| | - Xiangxi Zhang
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No. 324, Jingwu Road, Jinan, Shandong, 250021, China
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong University, Jinan, Shandong, 250021, China
| | - Liyuan Wang
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No. 324, Jingwu Road, Jinan, Shandong, 250021, China
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong University, Jinan, Shandong, 250021, China
| | - Yan Yun
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| | - Fang Li
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No. 324, Jingwu Road, Jinan, Shandong, 250021, China
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong University, Jinan, Shandong, 250021, China
| | - Yi Li
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong University, Jinan, Shandong, 250021, China
| | - Yuxin Liu
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No. 324, Jingwu Road, Jinan, Shandong, 250021, China
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong University, Jinan, Shandong, 250021, China
| | - Shouji Zhang
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No. 324, Jingwu Road, Jinan, Shandong, 250021, China
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong University, Jinan, Shandong, 250021, China
| | - Chengwei Zou
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No. 324, Jingwu Road, Jinan, Shandong, 250021, China.
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong University, Jinan, Shandong, 250021, China.
| | - Haizhou Zhang
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No. 324, Jingwu Road, Jinan, Shandong, 250021, China.
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong University, Jinan, Shandong, 250021, China.
| | - Xiaochun Ma
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No. 324, Jingwu Road, Jinan, Shandong, 250021, China.
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong University, Jinan, Shandong, 250021, China.
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