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Erciyes D, Ozden Tok O, Yurdakul S, Bakan S, Goktekin O. P1490 Congenital right coronary artery fistula into right atrium diagnosed with help of multimodality imaging. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Coronary artery fistula (CAF) is an anomaly in which abnormal connections are present between the coronary artery and the cardiac chambers or a major vessel. It is an uncommon anomaly with an estimated incidence of 1 in 50,000 live births and usually occurs in isolation.
We report a case of CAF into right atrium in a patient who admitted to our outpatient department with dyspnea and fatique. With help of transthoracic echocardiography (TTE), transesophageal echocardiography (TOE) and cardiac computerized tomography (CCT) we put the definite diagnosis and decided to close this fistula percutaneously with a PDA occluder.
Case
A 43-year- old male admitted to our outpatient department with complaints of exertional dyspnea and fatique for 5 years. His physical examination revealed a holosystolic murmur on the aortic valve area. His TTE showed enlarged right heart chambers with a high pulmonary artery systolic pressure (50 mmHg) and a suspicious flow from the aortic root into right atrium. Qp/Qs was 2.1. TOE depicted a shunt between aorta and right atrium as well, we couldn’t truly demonstrate the connection though .
In order to define the defect precisely, we performed a cardiac CT. Cardiac CT clearly showed a markedly dilated and mildly tortuous and calcified fistula arising from the osteal part of right coronary artery draining into right atrium. Right coronary artery was thin and there was no stenosis. Cardiac CT helped us to exclude coronary arter disease as well.
As it was suitable to close percutaneously, we decided to close it with a PDA occluder.
Conclusion
CAF is a rare, generally congenital anomaly and may cause right heart chamber dilatation and pulmonary hypertension if the diagnosis is missed. It is important to support and clarify the underlying pathology with help of other cardiovascular imaging modalities like cardiac CT and cardiac magnetic resonance imaging (CMR), if TTE and TOE cannot demonstrate us the exact pathology.In our case our choice of extra method was cardiac CT, as we wanted to exclude accompanying coronary artery disease at the same time. In today’s era, the use of multimodality imaging is increasing with a tremendous rate and it helps clinical cardiologists, cardiovascular imaging specialists and interventional cardiologists all.
Abstract P1490 Figure. 2D,3D TOE and CCT images of CAF
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Affiliation(s)
- D Erciyes
- Florence Nightingale Hospital, Cardiology, Istanbul, Turkey
| | - O Ozden Tok
- Memorial Bahcelievler Hospital, Istanbul, Turkey
| | - S Yurdakul
- Florence Nightingale Hospital, Cardiology, Istanbul, Turkey
| | - S Bakan
- Memorial Bahcelievler Hospital, Istanbul, Turkey
| | - O Goktekin
- Memorial Bahcelievler Hospital, Istanbul, Turkey
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Khaykin Y, Chen MS, Marrouche NF, Saliba WI, Schweikert R, Bash D, Williams-Andrews M, Saad EB, Burkhardt JD, Bhargava M, Joseph G, Rossillo A, Erciyes D, Martin D, Natale A. A25-6 Structural heart disease does not affect outcomes of pulmonary vein isolation for treatment of atrial fibrillation. Europace 2003. [DOI: 10.1016/eupace/4.supplement_2.b38-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Y. Khaykin
- Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - M. S. Chen
- Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | | - W. I. Saliba
- Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | | - D. Bash
- Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | | - E. B. Saad
- Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | | - M. Bhargava
- Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - G. Joseph
- Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - A. Rossillo
- Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - D. Erciyes
- Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - D. Martin
- Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - A. Natale
- Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Erciyes D, Mousseaux E, Cabanes L, Dougados M, Mallet V, Erlinger S, Gandjbakhch I, Duboc D, Fouchard J. [Pericardial and myocardial adiastole in rheumatoid polyarthritis]. Arch Mal Coeur Vaiss 1999; 92:1381-4. [PMID: 10562906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
The authors describe a case of clinical, echocardiographic and haemodynamic adiastole in a man with severe rheumatoid arthritis with a previous history of pericardial effusion. The adiastole was mixed, fibrous pericarditis, confirmed by ultra fast CT scan and at surgery; myocardial adiastole was suspected on finding thickening of the ventricular walls (in the absence of hypertension and coronary artery disease) and, unfortunately, confirmed by the persistence of adiastole despite very satisfactory pericardectomy. The authors underline the involvement of the three cardiac tunics in rheumatoid arthritis and the value of different diagnostic methods in the differentiation between constrictive pericarditis and restrictive cardiomyopathy.
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Affiliation(s)
- D Erciyes
- Service des maladies cardiovasculaires, hôpital Cochin, Paris
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Spaulding C, Cador R, Monségu J, Py A, Belaouchi F, Erciyes D, Weber S. [Transluminal coronary angioplasty in the acute phase of myocardial infarction]. Arch Mal Coeur Vaiss 1998; 91 Spec No 2:27-31. [PMID: 9749273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The objective of the treatment of myocardial infarction is to reestablish patency of the occluded artery as soon as possible. Two methods have been validated: intravenous thrombolysis which is easy to perform, and transluminal coronary angioplasty requiring expensive infrastructures and a skilled medical team but which has a higher success rate of restoring arterial patency. Angioplasty is indicated in cardiogenic shock and cases in which there is diagnostic uncertainty or a contraindication to thrombolysis. In addition, its superiority over thrombolysis has been clearly demonstrated in the following indications: 1) primary angioplasty if proper facilities with an experienced team are available in less than 45 minutes and 2) after failed thrombolysis (rescue angioplasty). The use of stents improves the results of primary angioplasty. Angioplasty and thrombolysis are not rival techniques: the choice depends on local conditions (proximity to a catheterization laboratory with a trained medical team) and the clinical context (presence of "high-risk" criteria). Their association (prehospital thrombolysis followed by immediate angioplasty) is the object of prospective clinical trials.
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Affiliation(s)
- C Spaulding
- Service de cardiologie, hôpital Cochin, Paris
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