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Popa RM, Ispas AF, Manea RM. A Rare Case of Left Anterior Descending Coronary Artery to Pulmonary Trunk Fistula Associated with Takotsubo Cardiomyopathy. Diagnostics (Basel) 2023; 13:2751. [PMID: 37685289 PMCID: PMC10487198 DOI: 10.3390/diagnostics13172751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 08/18/2023] [Accepted: 08/20/2023] [Indexed: 09/10/2023] Open
Abstract
Coronary-artery-to-pulmonary-artery fistulae represent rare vascular anomalies defined as abnormal communications between the coronary arteries and the pulmonary arterial system. Takotsubo Syndrome represents a stress-induced cardiomyopathy defined by transient regional systolic dysfunction of the left ventricle, with minimal elevation of cardiac biomarkers, without angiographic evidence of obstructive coronary artery disease. We hereby richly illustrate an unusual and rare case of a female patient with Takotsubo Cardiomyopathy and left-anterior-descending-coronary-artery-to-pulmonary-trunk fistula through multi-modality imaging evaluations, obtaining a detailed anatomical representation of the coronary arteries and the fistulous connection, which further guided the optimal treatment strategy. The patient was treated conservatively. The main teaching points of this case are the following: (1) The coronary fistula may represent just an incidental finding in a Takotsubo Cardiomyopathy clinical scenario. (2) The particularly rare association between left-anterior-descending-coronary-artery-to-pulmonary-trunk fistula and Takotsubo Cardiomyopathy presentation is mainly due to the stress-induced overstimulation of myocardial beta-1 receptors, accentuating the coronary steal phenomenon in the setting of the coronary fistula, manifesting as anginal pain, and also the stress-induced adrenergic drive causing the Takotsubo-like presentation with apical ballooning of the left ventricle.
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Affiliation(s)
- Ramona Mihaela Popa
- Department of Radiology and Medical Imaging, Clinical Emergency County Hospital of Brașov, 500326 Brașov, Romania
| | - Alexandru Florin Ispas
- Department of Interventional Cardiology, Clinical Emergency County Hospital of Brașov, 500326 Brașov, Romania;
| | - Rosana Mihaela Manea
- Department of Radiology and Medical Imaging, Clinical Emergency County Hospital of Brașov, 500326 Brașov, Romania
- Faculty of Medicine, “Transilvania” University of Brașov, 500019 Brașov, Romania
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2
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Zhang S, Wang J, Song F, Yang F, Li F, Liu S, Ma J, Zhang H, Ma X. Case report: Left atrial myxoma with morphology of cavernous hemangioma supplied by the right coronary artery. Front Cardiovasc Med 2023; 10:1207339. [PMID: 37593147 PMCID: PMC10427500 DOI: 10.3389/fcvm.2023.1207339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/17/2023] [Indexed: 08/19/2023] Open
Abstract
Here, we report an unusual case of left atrial myxoma presented with morphology of cavernous hemangioma supplied by the right coronary artery. Surgical resection of the left atrium myxoma was performed, and the patient experienced an uneventful recovery during hospitalization.
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Affiliation(s)
- Shouji Zhang
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Junlin Wang
- Department of Anesthesiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Fahang Song
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Fan Yang
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
| | - Fang Li
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Shangxin Liu
- Imaging Department, Pingyin Chinese Medicine Hospital, Jinan, China
| | - Jiwei Ma
- Department of Pathology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Haizhou Zhang
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Xiaochun Ma
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
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3
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Gong S, Marasco S, Wong M, Hiscock M. Left main coronary artery to pulmonary artery fistula presenting as angina and ventricular tachycardia - A case report and literature review. Clin Case Rep 2023; 11:e7231. [PMID: 37143465 PMCID: PMC10151588 DOI: 10.1002/ccr3.7231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 02/23/2023] [Accepted: 04/04/2023] [Indexed: 05/06/2023] Open
Abstract
Coronary artery fistulae are an uncommon abnormality of the coronary arteries, but when hemodynamically significant can present as angina, dyspnea, and arrhythmia as a rare cause of functional myocardial ischemia via 'coronary steal phenomenon'.
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Affiliation(s)
- Simone Gong
- Department of CardiologyEpworth Hospital RichmondMelbourneVictoriaAustralia
- Department of MedicineUniversity of MelbourneMelbourneVictoriaAustralia
| | - Silvana Marasco
- Department of CardiologyEpworth Hospital RichmondMelbourneVictoriaAustralia
- CJOB Cardiothoracic Surgery DepartmentThe Alfred HospitalMelbourneVictoriaAustralia
- Department of SurgeryMonash UniversityMelbourneVictoriaAustralia
| | - Michael Wong
- Department of CardiologyEpworth Hospital RichmondMelbourneVictoriaAustralia
| | - Martin Hiscock
- Department of CardiologyEpworth Hospital RichmondMelbourneVictoriaAustralia
- Department of MedicineUniversity of MelbourneMelbourneVictoriaAustralia
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4
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Sohn B, Chang HW, Lee JH, Kim D, Kim J, Lim C, Park KH. Influence of Ipsilateral Graft Inflow to Arteriovenous Fistula for Hemodialysis in Coronary Bypass Surgery. J Clin Med 2022; 11:1053. [PMID: 35207327 DOI: 10.3390/jcm11041053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/07/2022] [Accepted: 02/14/2022] [Indexed: 11/17/2022] Open
Abstract
In coronary artery bypass grafting (CABG) for patients on hemodialysis, there has been concern about “coronary steal”. This study aims to evaluate the influence of using an in situ internal thoracic artery (ITA) ipsilateral to a preexisting arteriovenous fistula (AVF) in dialysis-dependent patients undergoing CABG. Between 2004 and 2018, dialysis-dependent patients with AVFs who underwent CABG were enrolled. According to the locational relationship of AVFs and in situ ITA grafts, the patients were divided into the ipsilateral group (n = 22) and the contralateral group (n = 21). Inverse probability weighting analysis was used to estimate and compare the late clinical outcomes. The late cardiac-related adverse events were not significantly different between the two groups: “major adverse cardiovascular and cerebrovascular events (MACCE)” (p = 0.090), “composite outcome of recurrent angina and coronary re-intervention” (p = 0.600). The in situ ITA graft of CABG on the ipsilateral side to AVF was not a significant risk factor for MACCE or the composite outcome of recurrent angina and coronary re-intervention. There was no statistically significant difference in the graft patency between the groups. Therefore, it might not be necessary to avoid using an in situ ITA on the ipsilateral side of an upper-arm AVF for optimal coronary artery bypass grafting in dialysis-dependent patients.
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5
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Bigler MR, Buffle E, Stoller M, Grossenbacher R, Tschannen C, Seiler C. Extracardiac coronary steal induced by upper limb hyperemia: a feature of internal mammary artery arteriogenesis. J Appl Physiol (1985) 2021; 131:905-913. [PMID: 34236245 DOI: 10.1152/japplphysiol.00082.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Function of naturally existing internal mammary artery (IMA)-to-coronary artery anastomoses has been shown by augmented blood supply to the coronary collateral circulation in response to IMA occlusion. Theoretically, this beneficial functional connection is invertible and can be linked to coronary steal, the verification of whose hypothesis would provide alternate proof to the mentioned functional evidence. This was an observational study including 40 patients with chronic coronary syndrome, distal IMA occlusion, and upper limb hyperemia (verum group), and 40 propensity score matched controls (placebo group) without IMA occlusion or hyperemia. Primary study end point was the intergroup difference and temporal development in coronary collateral function (i.e., collateral flow index; CFI) as obtained at 30, 45, and 60 s following a proximal coronary artery balloon occlusion. CFI is the ratio between simultaneous mean coronary occlusive pressure divided by mean aortic pressure both subtracted by central venous pressure. To provoke a steal phenomenon, upper limb hyperemia was induced by upper arm blood pressure cuff deflation following a 5-min suprasystolic inflation ipsilateral to the sensor-wired coronary artery with release immediately after the first CFI measurement. Between the first and the second CFI measurement, CFI change (i.e., CFI@45s - CFI@30s) was absent in the verum group whereas there was CFI recruitment in the placebo group: 0.000 ± 0.023 and +0.009 ± 0.013, respectively; P = 0.032. Among patients with artificial distal IMA occlusion, induction of ipsilateral upper limb hyperemia provokes extracardiac coronary steal as expressed by temporarily absent collateral recruitment as it normally takes place without upper limb hyperemia.NEW & NOTEWORTHY Induction of ipsilateral upper limb hyperemia provokes extracardiac coronary steal among patients with artificial distal internal mammary artery occlusion. Coronary steal via the occluded internal mammary arteries serves as alternate proof of concept of the already existing evidence of their functional extracoronary collateral supply.
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Affiliation(s)
- Marius Reto Bigler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Eric Buffle
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michael Stoller
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Raphael Grossenbacher
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christine Tschannen
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christian Seiler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Affiliation(s)
- Nils P Johnson
- Division of Cardiology Department of Medicine Weatherhead PET CenterMcGovern Medical School at UTHealth and Memorial Hermann Hospital Houston TX
| | - Richard L Kirkeeide
- Division of Cardiology Department of Medicine Weatherhead PET CenterMcGovern Medical School at UTHealth and Memorial Hermann Hospital Houston TX
| | - K Lance Gould
- Division of Cardiology Department of Medicine Weatherhead PET CenterMcGovern Medical School at UTHealth and Memorial Hermann Hospital Houston TX
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7
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Zhang H, Wang F, Yang Z, Wang C. Giant cardiac myxoma presenting with exertional angina: Coronary steal due to neovascularization? J Card Surg 2021; 36:1134-1135. [PMID: 33476471 DOI: 10.1111/jocs.15366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/05/2021] [Accepted: 01/11/2021] [Indexed: 12/01/2022]
Abstract
Myxoma is the most common benign tumor of the heart. Most patients present with no symptoms, only a few patients present with exertional dyspnea and stroke. We introduce this rare case presenting with exertional angina, which was caused by coronary steal due to neovascularization, proved by coronary angiography and cardiac stress testing.
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Affiliation(s)
- Hongqiang Zhang
- Department of Cardiac Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Fanshun Wang
- Department of Cardiac Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Zhaohua Yang
- Department of Cardiac Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Chunsheng Wang
- Department of Cardiac Surgery, Zhongshan Hospital Fudan University, Shanghai, China
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Sagar P, Sivakumar K. Transcatheter occlusion of an anomalous origin of left coronary artery from pulmonary artery in an adult as an alternative to surgery. Cardiol Young 2021; 31:155-8. [PMID: 33073747 DOI: 10.1017/S1047951120003418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Anomalous origin of the left coronary artery from the pulmonary artery causes heart failure and death in infancy. In rare adult survivors with well-developed collaterals, surgical left coronary ligation to arrest steal is often combined with bypass grafting. Transcatheter left coronary artery closure in a symptomatic adult as an alternative to surgical ligation resulted in complete resolution of inducible ischaemia on myocardial perfusion imaging.
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9
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Bhasin D, Arora GK, Giridhara P, Gupta A, Isser HS, Bansal S. Coronary-Cameral Fistula to Pulmonary Artery: An Innocent Bystander? J Invasive Cardiol 2021; 33:E70. [PMID: 33385992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Coronary-cameral fistula (CCF) is a rare congenital communication between a coronary artery and a cardiac chamber or a great vessel. Most patients are asymptomatic and these lesions are incidentally detected during coronary angiography, with the reported incidence being up to 0.2%. The most frequent draining sites are right ventricle, right atrium, and pulmonary arteries, with less frequent drainage to the left side of the heart. The majority of CCFs are hemodynamically inconsequential and do not require treatment. However, when large, these lesions can cause myocardial ischemia by causing coronary steal or high-output heart failure, and should be treated. Treatment modalities include transcatheter closure with embolic agents (microcoil or gelfoam) and surgical ligation. Choice of therapy is governed by size of the CCF, tortuosity of the feeder channel, size of the communication to prevent embolization, and concomitant coronary artery disease.
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Affiliation(s)
| | | | | | | | - H S Isser
- Department of Cardiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi-110029, India.
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10
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Valencia D, Linares J, Das S, Valencia V, Yatsynovich Y. Uncommon Coronary Abnormalities in a Patient with Discoid Lupus Erythematosus. Int J Angiol 2020; 29:260-262. [PMID: 33268978 DOI: 10.1055/s-0039-1696978] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
A 43-year-old male presented with shortness of breath and palpitations. Physical examination was significant for skin lichenification, an erythematous maculopapular rash with annular plaques, a fissured tongue, and digital clubbing. Electrocardiogram captured a supraventricular tachycardia and right bundle branch block. Left heart catheterization found several proximal left coronary artery branch aneurysms, a right coronary-pulmonary artery fistula, venous-luminal vessels between the right heart chambers and cardiac veins, and thebesian venous lakes. Functional cardiac capacity was reduced, with left ventricular ejection fraction of 35 to 40%, on ventriculogram. A diagnosis of discoid lupus erythematosus was established after skin biopsies revealed systemic lupus erythematosus-like features but negative anti-nuclear, anti-Smith, anti-ds-deoxyribonucleic acid, anti-Ro, and anti-La antibodies. The case reported is unique, in that while our patient had pathologic electrophysiologic changes typically seen with autoimmune disease, the patient had many anatomical cardiac anomalies without atherosclerotic coronary disease. It is uncertain whether these findings are purely incidental or are related to an underlying genetic disorder.
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Affiliation(s)
- Damian Valencia
- Department of Internal Medicine, Kettering Medical Center, Kettering, Ohio
| | - Juan Linares
- Department of Internal Medicine, Kettering Medical Center, Kettering, Ohio
| | - Sulagna Das
- Department of Internal Medicine, Kettering Medical Center, Kettering, Ohio
| | - Victor Valencia
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Yan Yatsynovich
- Department of Internal Medicine, Kettering Medical Center, Kettering, Ohio
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Salabei JK, Fishman TJ, Asnake ZT, Calestino M. Persistent Postprandial Angina in a Patient With Gastroesophageal Reflux Disease: A Diagnostic Dilemma. Cureus 2020; 12:e9789. [PMID: 32953305 PMCID: PMC7491683 DOI: 10.7759/cureus.9789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/16/2020] [Indexed: 11/24/2022] Open
Abstract
Chest pain (CP) is a common reason for visits to the emergency department (ED). The underlying etiology of a good number of cases of CP can be diagnosed with adequate history taking and routine laboratory testing. However, atypical presentations of CP, in the settings of other causes of CP such as gastroesophageal reflux disease (GERD), can sometimes be tricky to diagnose with only routine lab tests and electrocardiogram (EKG). Herein, we present a 73-year-old male with a history of GERD and coronary artery disease who presented to our ED complaining of postprandial CP unaffected by exertion or rest. Initially, his symptoms were thought to be GERD-related but other heart-related causes of CP were considered due to the persistence of his CP postprandially. A cardiac stress test was subsequently done to rule out possible cardiac causes of his CP. His stress test was abnormal prompting heart catheterization that showed almost complete occlusion of his left anterior descending (LAD) and left circumflex (LCx) arteries. His symptoms resolved post-catheterization/stenting of his LAD and LCx arteries. He was later discharged unconditionally. His presentation highlights the required vigilance physicians must maintain when interrogating CP, even when other non-cardiac-related causes seem more plausible.
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Affiliation(s)
- Joshua K Salabei
- Internal Medicine, University of Central Florida College of Medicine, Hospital Corporation of America North Florida Division, Gainesville, USA
| | - Troy J Fishman
- Internal Medicine, University of Central Florida College of Medicine, Hospital Corporation of America North Florida Division, Gainesville, USA
| | - Zekarias T Asnake
- Internal Medicine, University of Central Florida College of Medicine, Hospital Corporation of America North Florida Division, Gainesville, USA
| | - Matthew Calestino
- Internal Medicine, North Florida Regional Medical Center, University of Central Florida, Gainesville, USA
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Matoq AA, Tsuda T. Effective myocardial perfusion and concomitant haemodynamic status determine the clinical diversity of anomalous left coronary artery from the pulmonary artery. Cardiol Young 2020; 30:362-8. [PMID: 31964440 DOI: 10.1017/S1047951119003299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Anomalous left coronary artery from the pulmonary artery is a rare congenital heart disease (CHD) with diverse clinical presentations despite the same anatomy. Factors determining this heterogeneous presentation are not well understood. METHOD AND RESULTS We retrospectively investigated 14 patients (12 females) who underwent surgical repair of anomalous left coronary artery from the pulmonary artery. These patients were divided into three groups based upon the severity of initial presentation: (1) severe, life-threatening condition (n = 5), (2) mild-to-moderate distress (n = 6), and (3) asymptomatic (n = 3). All patients presented with left ventricular dilation and retrograde flow in left coronary artery by echocardiogram. Eight patients in (1) and (2) presented with severe left ventricular dysfunction. All but one showed abnormal ECG consistent with myocardial ischemia or infarction. Asymptomatic patients had preserved left ventricular systolic function despite ischemic findings on ECG. In 13 patients after surgical repair, all but one normalised left ventricular geometry and systolic function, suggesting nearly full myocardial recovery upon improvement of myocardial perfusion; 8 patients had residual echogenic papillary muscle with variable degree of mitral regurgitation. CONCLUSIONS Evidence of myocardial ischemic injury was present in all patients with anomalous left coronary artery from the pulmonary artery regardless of their initial presentation. Retrograde flow in left coronary artery, implying collateral vessel development from right coronary artery to left coronary artery, was noted in all patients, yet only few patients had preserved systolic function at the time of diagnosis. The balance between effective myocardial perfusion and a deleterious fistulous flow provided by these collaterals and the simultaneous haemodynamic status are what determine the clinical diversity of anomalous left coronary artery from the pulmonary artery.
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Olson PC, Spagnola J, Nalluri N, Tamburrino F. Left internal mammary artery to pulmonary artery fistula causing coronary steal syndrome: A review of literature on therapy, intervention, and management. Catheter Cardiovasc Interv 2019; 94:E20-E22. [PMID: 30941867 DOI: 10.1002/ccd.28225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 03/23/2019] [Indexed: 11/09/2022]
Abstract
Coronary artery anomalies (CAA) are anatomical aberrations in the origin, structure, and course of the epicardial arteries. Literature has detailed common anomalies or fistulas formed because of coronary artery bypass grafting (CABG) manipulation of intrathoracic vessels. Despite the commonality of the CABG procedure, there are a few CAA and fistula findings which remain extremely rare. We present a case of left internal mammary artery to pulmonary artery fistula causing coronary steal syndrome that presented symptomatically as a malignant arrhythmia. Following a literature review of therapy, intervention, and management we recommend a team based approach when faced with this extremely rare case presentation. The goal of management should to reduce symptoms, and ischemia, by reducing or stopping flow through the fistula and out of the coronary blood supply.
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Affiliation(s)
- Peter C Olson
- Department of Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, New York
| | - Jonathan Spagnola
- Department of Cardiology, Staten Island University Hospital, Northwell Health, Staten Island, New York
| | - Nikhil Nalluri
- Department of Cardiology, Staten Island University Hospital, Northwell Health, Staten Island, New York
| | - Frank Tamburrino
- Department of Cardiology, Staten Island University Hospital, Northwell Health, Staten Island, New York
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Shimada S, Taketazu M, Sato M, Nii M, Shirai M. Heart failure and coronary ischemia in a neonate with right coronary artery fistula. Pediatr Int 2019; 61:417-418. [PMID: 30989753 DOI: 10.1111/ped.13807] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 12/16/2018] [Accepted: 02/07/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Sorachi Shimada
- Department of Pediatrics, Asahikawa Kosei General Hospital, Asahikawa, Hokkaido, Japan
| | - Mio Taketazu
- Department of Pediatrics, Asahikawa Kosei General Hospital, Asahikawa, Hokkaido, Japan
| | - Masayuki Sato
- Department of Pediatrics, Asahikawa Kosei General Hospital, Asahikawa, Hokkaido, Japan
| | - Mitsumaro Nii
- Department of Pediatrics, Asahikawa Kosei General Hospital, Asahikawa, Hokkaido, Japan
| | - Masaru Shirai
- Department of Pediatrics, Asahikawa Kosei General Hospital, Asahikawa, Hokkaido, Japan
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15
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El-Said HG, Pockett CR, Moore JW. Percutaneous obliteration of left ventricular cavity to eliminate aortic regurgitation and presumed coronary steal in an infant with hypoplastic left heart syndrome. Catheter Cardiovasc Interv 2017; 90:982-985. [PMID: 28568976 DOI: 10.1002/ccd.27138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 04/29/2017] [Accepted: 05/03/2017] [Indexed: 11/07/2022]
Abstract
The phenomenon of coronary steal is well known in the setting of HLHS (Hypoplastic Left Heart Syndrome) early after the Classical Norwood Operation. We report a rare case of an infant with HLHS [Severe Aortic Stenosis (AS), Mitral Stenosis (MS) and small Left Ventricle (LV)], who developed aortic regurgitation and presumed coronary steal late after the Sano Modification of the Norwood Procedure. Coronary steal developed secondary to progressive aortic and mitral regurgitation and resulted in poor right ventricular function and severe tricuspid regurgitation. We describe a novel interventional approach for obliteration of the LV cavity by using hydrogel coils. LV obliteration eliminated the presumed steal and resulted in improvement in ventricular function, tricuspid regurgitation and clinical course.
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Affiliation(s)
- Howaida G El-Said
- Rady Children's Hospital, San Diego, University of California, San Diego, California
- Center at which the work was performed: Rady Children's Hospital, San Diego, California
| | - Charissa R Pockett
- Rady Children's Hospital, San Diego, University of California, San Diego, California
- Center at which the work was performed: Rady Children's Hospital, San Diego, California
| | - John W Moore
- Rady Children's Hospital, San Diego, University of California, San Diego, California
- Center at which the work was performed: Rady Children's Hospital, San Diego, California
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Abstract
A 75-year-old woman who had previously been diagnosed with Bland-White-Garland syndrome was admitted to our hospital for acute decompensated heart failure (ADHF). Following her recovery from ADHF, pharmacologic stress myocardial scintigraphy revealed myocardial ischemia in the basal anterior area of the left ventricle. Moreover, myocardial scintigraphy showed the improvement of the myocardial ischemia after 6 months of nicorandil administration.
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Affiliation(s)
- Shun Morishita
- Department of Medicine II, Kansai Medical University, Japan
| | - Hirofumi Maeba
- Department of Medicine II, Kansai Medical University, Japan
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17
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Patra C, Singh NG, Manjunatha N, Bhatt A. Anaesthetic management of infants posted for repair of anomalous origin of left coronary artery from pulmonary artery. Indian J Anaesth 2017; 61:676-678. [PMID: 28890565 PMCID: PMC5579860 DOI: 10.4103/ija.ija_212_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
First described in 1908, anomalous origin of left coronary artery from pulmonary artery is a very rare congenital anomaly. Here, the right coronary artery is usually enlarged and has a normal origin from aorta. Numerous collaterals connect the two coronary arteries over right ventricular outflow tract or interventricular septum. It is one of the most common causes of myocardial ischaemia and infarction in children.
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Affiliation(s)
- Chitralekha Patra
- Department of Cardiac Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India
| | - Naveen G Singh
- Department of Cardiac Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India
| | - N Manjunatha
- Department of Cardiac Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India
| | - Anand Bhatt
- Department of Cardiac Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India
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Kakizaki R, Tojo T, Minami Y, Koitabashi T, Woodhams R, Shimohama T, Ishii M, Ako J. Myocardial ischemia induced by major aortopulmonary collateral arteries treated with transcatheter coil embolization. Clin Case Rep 2017; 5:1022-1025. [PMID: 28588860 PMCID: PMC5457975 DOI: 10.1002/ccr3.980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 03/23/2017] [Accepted: 03/28/2017] [Indexed: 11/27/2022] Open
Abstract
Major aortopulmonary collateral arteries branching from coronary arteries may cause coronary steal. The careful follow‐up is needed irrespective of symptoms because increasing physical activities and oxygen demand along with the age may induce myocardial ischemia. Transcatheter intervention by well‐trained physician would be a treatment option in patients with myocardial ischemia.
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Affiliation(s)
- Ryota Kakizaki
- Department of Cardiovascular Medicine Kitasato University School of Medicine Sagamihara Japan
| | - Taiki Tojo
- Department of Cardiovascular Medicine Kitasato University School of Medicine Sagamihara Japan
| | - Yoshiyasu Minami
- Department of Cardiovascular Medicine Kitasato University School of Medicine Sagamihara Japan
| | - Toshimi Koitabashi
- Department of Cardiovascular Medicine Kitasato University School of Medicine Sagamihara Japan
| | - Reiko Woodhams
- Department of Diagnostic Radiology Kitasato University School of Medicine Sagamihara Japan
| | - Takao Shimohama
- Department of Cardiovascular Medicine Kitasato University School of Medicine Sagamihara Japan
| | - Masahiro Ishii
- Department of Pediatrics Kitasato University School of Medicine Sagamihara Japan
| | - Junya Ako
- Department of Cardiovascular Medicine Kitasato University School of Medicine Sagamihara Japan
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19
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Haddad LM, Magill HL, Sathanandam SK. Management of anomalous circumflex coronary artery from the neo-pulmonary artery in an adolescent following neonatal arterial switch operation. Catheter Cardiovasc Interv 2014; 85:625-8. [PMID: 25044498 DOI: 10.1002/ccd.25599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 06/17/2014] [Accepted: 07/06/2014] [Indexed: 11/09/2022]
Abstract
A 15-year-old male with transposition of the great arteries presented with exertional chest pain. He was found to have a circumflex coronary artery from the neo-pulmonary artery that had not been transferred during his arterial switch operation. The circumflex coronary artery, fed through collaterals from a re-implanted single coronary artery, resulted in coronary steal. This report describes a management pathway to treat this rare anomaly.
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Affiliation(s)
- Lauren M Haddad
- Division of Cardiology, Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee
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20
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Bartoli CR, Rogers BD, Ionan CE, Pantalos GM. End-diastolic flow reversal limits the efficacy of pediatric intra-aortic balloon pump counterpulsation. J Thorac Cardiovasc Surg 2014; 147:1660-7. [PMID: 24139614 PMCID: PMC3988268 DOI: 10.1016/j.jtcvs.2013.08.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 08/06/2013] [Accepted: 08/16/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Counterpulsation with an intra-aortic balloon pump (IABP) has not achieved the same success or clinical use in pediatric patients as in adults. In a pediatric animal model, IABP efficacy was investigated to determine whether IABP timing with a high-fidelity blood pressure signal may improve counterpulsation therapy versus a low-fidelity signal. METHODS In Yorkshire piglets (n = 19; weight, 13.0 ± 0.5 kg) with coronary ligation-induced acute ischemic left ventricular failure, pediatric IABPs (5 or 7 mL) were placed in the descending thoracic aorta. Inflation and deflation were timed with traditional criteria from low-fidelity (fluid-filled) and high-fidelity (micromanometer) blood pressure signals during 1:1 support. Aortic, carotid, and coronary hemodynamics were measured with pressure and flow transducers. Myocardial oxygen consumption was calculated from coronary sinus and arterial blood samples. Left ventricular myocardial blood flow and end-organ blood flow were measured with microspheres. RESULTS Despite significant suprasystolic diastolic augmentation and afterload reduction at heart rates of 105 ± 3 beats per minute, left ventricular myocardial blood flow, myocardial oxygen consumption, the myocardial oxygen supply/demand relationship, cardiac output, and end-organ blood flow did not change. Statistically significant end-diastolic coronary, carotid, and aortic flow reversal occurred with IABP deflation. Inflation and deflation timed with a high-fidelity versus low-fidelity signal did not attenuate systemic flow reversal or improve the myocardial oxygen supply/demand relationship. CONCLUSIONS Systemic end-diastolic flow reversal limited counterpulsation efficacy in a pediatric model of acute left ventricular failure. Adjustment of IABP inflation and deflation timing with traditional criteria and a high-fidelity blood pressure waveform did not improve IABP efficacy or attenuate flow reversal. End-diastolic flow reversal may limit the efficacy of IABP counterpulsation therapy in pediatric patients with traditional timing criteria. Investigation of alternative deflation timing strategies is warranted.
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Affiliation(s)
- Carlo R Bartoli
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa; MD/PhD Program, University of Louisville School of Medicine, Louisville, Ky
| | | | - Constantine E Ionan
- Cardiovascular Innovation Institute, University of Louisville, Louisville, Ky
| | - George M Pantalos
- Cardiovascular Innovation Institute, University of Louisville, Louisville, Ky; Department of Bioengineering, University of Louisville, Louisville, Ky; Department of Surgery, University of Louisville, Louisville, Ky.
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21
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Saileela R, Shanthi C, Manohar K, Subramanyan R, Cherian K. Myocardial ischemia following arterial switch operation: An uncommon etiology. Ann Pediatr Cardiol 2012; 5:194-6. [PMID: 23129913 PMCID: PMC3487212 DOI: 10.4103/0974-2069.99626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Myocardial ischemia following arterial switch operation (ASO) usually occurs due to coronary ostial narrowing that might result from technical failure in translocation of the coronary arteries to the neoaorta. We present an unusual case report of neonatal myocardial ischemia caused by coronary steal secondary to aortopulmonary collaterals, following ASO in transposition of great arteries.
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Affiliation(s)
- R Saileela
- Department of Pediatric Cardiology and Cardiothoracic Surgery, Frontier Lifeline and Dr. K. M. Cherian Heart Foundation, Chennai, India
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22
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Walia I, Arora HS, Barker EA, Delgado RM, Frazier OH. Snake heart: a case of atavism in a human being. Tex Heart Inst J 2010; 37:687-690. [PMID: 21224948 PMCID: PMC3014134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Atavism is the rare reappearance, in a modern organism, of a trait from a distant evolutionary ancestor. We describe an apparent case of atavism involving a 59-year-old man with chest pain whose coronary circulation and myocardial architecture resembled those of the reptilian heart. The chest pain was attributed to a coronary steal phenomenon. The patient was discharged from the hospital on a heightened regimen of β-blockers, and his symptoms improved significantly. To our knowledge, this is only the 2nd reported clinical case of a human coronary circulation similar to that of reptiles.
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Affiliation(s)
- Ishmeet Walia
- Department of Cardiology, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas 77030, USA
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23
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Abstract
Myocardial perfusion imaging with coronary vasodilators is routinely used for patients with suspected coronary disease who are unable to exercise. Since these agents work by increasing blood flow without significantly changing myocardial oxygen demand, they generally do not produce ischemia. A minority of patients show evidence of ischemia which some investigators suggest is due to a coronary steal phenomenon, but this has been challenged by several investigators. We present the case of a patient who developed severe transmural myocardial ischemia manifested by ST-segment elevation and severe perfusion defects which occurred after dipyridamole administration and which were reversed with aminophylline and nitroglycerin. This case supports the notion that coronary vasodilation with dipyridamole can induce a coronary steal.
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Affiliation(s)
- C L Hansen
- Section of Cardiology, Temple University Hospital, Philadelphia, PA 19140, USA
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