RESUMO
Pulmonary artery dissection is a rare and fatal disease. Diagnosis is mainly made during autopsy because most patients die suddenly due to pulmonary artery dissection in the pericardium resulting in pericardial tamponade. The optimum management is not clearly defined because of the paucity of cases in the literature. We describe the case of an 81-year-old man, affected by rheumatoid arthritis and with history of aortic valve replacement surgery, who attended an emergency department for non-specific symptoms, started complaining of chest pain rapidly deteriorated into cardiac shock. Computed tomography scan, performed on suspicion of an acute aortic pathology and/or a pulmonary embolism, allowed the identification of pulmonary artery dissection associated with aorto-pulmonary fistula. Despite early diagnosis in the emergency department, the outcome was unfortunately fatal.
Assuntos
Dissecção Aórtica , Artéria Pulmonar , Humanos , Idoso de 80 Anos ou mais , Masculino , Dissecção Aórtica/cirurgia , Dissecção Aórtica/diagnóstico , Dissecção Aórtica/diagnóstico por imagem , Artéria Pulmonar/diagnóstico por imagem , Evolução Fatal , Tomografia Computadorizada por Raios X , Fístula Vascular/cirurgia , Fístula Vascular/diagnóstico , Fístula Vascular/diagnóstico por imagemRESUMO
Arterio-ureteral fistulas (AUFs), which are relatively rare but potentially life-threatening, require prompt diagnosis and treatment. We reported a case of AUFs following robot-assisted laparoscopic radical cystectomy (RARC) with extended pelvic lymph node dissection and ileal conduit urinary diversion for muscle-invasive bladder cancer, which resulted in massive hemorrhage. Urine leaked from the anastomosis between the ureter, and the end of the ileal conduit was infected, which resulted in an AUF between the pseudoaneurysm of the right common iliac artery and the ureter. The AUF was managed successfully by vascular intervention with an arterial stent graft.
Assuntos
Falso Aneurisma , Cistectomia , Artéria Ilíaca , Laparoscopia , Procedimentos Cirúrgicos Robóticos , Doenças Ureterais , Fístula Urinária , Fístula Vascular , Humanos , Cistectomia/efeitos adversos , Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Fístula Urinária/etiologia , Fístula Urinária/cirurgia , Doenças Ureterais/etiologia , Doenças Ureterais/cirurgia , Artéria Ilíaca/cirurgia , Fístula Vascular/etiologia , Fístula Vascular/cirurgia , Masculino , Complicações Pós-Operatórias/cirurgia , Complicações Pós-Operatórias/etiologia , Neoplasias da Bexiga Urinária/cirurgia , Idoso , Pessoa de Meia-IdadeRESUMO
Coronary artery fistula is a rare anomaly involving the coronary artery and a heart chamber or vessel. Percutaneous intervention has been shown to be effective and safe in fistulas that are small and nontortuous; however, it is not an absolute contraindication in fistulas that are large and tortuous. We report a delayed diagnosis of a single, large-diameter, tortuous coronary artery fistula that manifested as myocardial ischaemia due to the steal phenomenon in a 49 year old male. The undesirable connection was successfully obliterated by percutaneous embolisation, followed by an improvement in symptoms and daily activities. Steal phenomenon is the fundamental mechanism of myocardial ischaemia in coronary artery fistula, as confirmed by improvement in symptoms and coronary artery perfusion following occlusion of the fistula. Percutaneous catheterization is safe and effective for coronary artery fistula closure, and the occlusion site should be precise to achieve complete occlusion and prevent complications.
Assuntos
Embolização Terapêutica , Humanos , Masculino , Pessoa de Meia-Idade , Embolização Terapêutica/métodos , Anomalias dos Vasos Coronários/terapia , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/diagnóstico por imagem , Angiografia Coronária , Fístula Vascular/terapia , Fístula Vascular/diagnóstico por imagem , Isquemia Miocárdica/terapia , Isquemia Miocárdica/etiologia , Cateterismo Cardíaco/métodos , Vasos Coronários/diagnóstico por imagemRESUMO
BACKGROUND: An aortoesophageal fistula can prove to be fatal. Salvage thoracic endovascular aortic repair as a bridging therapy and radical surgery with thoracotomy should be considered while treating aortoesophageal fistula without spontaneous closure. Moreover, it is essential to select a technique that reduces the risk of reinfection. Here we report a rare case of a ruptured thoracic aortic aneurysm related to esophageal perforation by a fish bone that led to massive hematemesis and shock, and the surgical treatment of an aortoesophageal fistula that developed after salvage thoracic endovascular aortic repair. CASE PRESENTATION: A 70-year-old Japanese female patient was admitted with hematemesis, thoracic pain, and shock related to esophageal perforation of a ruptured descending aortic aneurysm caused by fish bone aspiration and esophageal perforation 1 month previously. An emergency thoracic endovascular aortic repair was performed. Postoperatively, an aortoesophageal fistula that remained open and a food intake-related increase in the inflammatory response was noted. Radical blood-vessel prosthesis implantation and fistula closure were performed. The patient's postoperative course was favorable and the patient was discharged 22 days after the blood vessel prosthesis implantation. CONCLUSION: Such a case of rupture of a descending aortic aneurysm related to perforation by a fish bone and an aortoesophageal fistula is considerably rare. Thus, we report the therapeutic strategy of this particular case and review the relevant literature.
Assuntos
Aneurisma da Aorta Torácica , Ruptura Aórtica , Procedimentos Endovasculares , Fístula Esofágica , Perfuração Esofágica , Humanos , Feminino , Fístula Esofágica/cirurgia , Fístula Esofágica/etiologia , Idoso , Procedimentos Endovasculares/métodos , Aneurisma da Aorta Torácica/cirurgia , Ruptura Aórtica/cirurgia , Perfuração Esofágica/cirurgia , Perfuração Esofágica/etiologia , Fístula Vascular/cirurgia , Fístula Vascular/etiologia , Implante de Prótese Vascular , Terapia de Salvação/métodos , Animais , Hematemese/etiologia , Doenças da Aorta/cirurgia , Doenças da Aorta/etiologia , Aorta Torácica/cirurgia , Resultado do Tratamento , Peixes , Correção Endovascular de AneurismaRESUMO
Primary aortoenteric fistulas (AEF) are rare. The majority of these are due to atherosclerotic aortic aneurysms. Mycotic aortic aneurysms leading to primary AEF are exceedingly uncommon. Here we report a rare case of primary AEF secondary to Salmonella-related mycotic aneurysm and discuss the diagnostic and therapeutic issues.
Assuntos
Aneurisma Infectado , Fístula Intestinal , Salmonella typhi , Fístula Vascular , Humanos , Aneurisma Infectado/diagnóstico , Aneurisma Infectado/microbiologia , Fístula Intestinal/microbiologia , Fístula Intestinal/diagnóstico , Fístula Intestinal/etiologia , Salmonella typhi/isolamento & purificação , Fístula Vascular/diagnóstico , Fístula Vascular/microbiologia , Masculino , Febre Tifoide/diagnóstico , Febre Tifoide/complicações , Pessoa de Meia-Idade , Infecções por Salmonella/diagnóstico , Infecções por Salmonella/complicaçõesRESUMO
BACKGROUND: Congenital left circumflex coronary artery fistula (LCX-CAF) is a relatively rare type of coronary artery fistula (CAF); little is known about the outcomes of transcatheter closure (TCC) of LCX-CAF. METHODS AND RESULTS: All consecutive patients admitted to Fuwai Hospital and scheduled for TCC of LCX-CAF between January 2012 and December 2022 were reviewed retrospectively. Of the 25 consecutive patients (mean [±SD] age 34±20 years; 48% male) admitted and scheduled for TCC of congenital LCX-CAF, the procedure was feasible in 22 (77.3%). The mean (±SD) diameter of the fistulas was 6.99±2.04 mm; 21 (84%) patients had a large fistula (i.e., diameter >2-fold greater than non-feeding coronary artery). Occluders were deployed via a transarterial approach and arteriovenous loop in 6 (27.3%) and 16 (72.7%) patients, respectively. No procedural complications were recorded. Although the procedural success rates are similar for single LCX-CAF and left anterior descending CAF (81.25% vs. 92.86%; P=0.602), the mean time from initial angiography to first occluder deployment is significantly longer for LCX-CAF (83.06±36.07 vs. 36.00±9.49 min; P<0.001). The mean (±SD) follow-up time was 62.2±45.5 months. The incidence of myocardial infarction and recanalization of the fistula was 4.5% (1/22) and 9.1% (2/22), respectively. CONCLUSIONS: TCC of LCX-CAF is a feasible and effective alternative to surgical repair, with comparable outcomes in selected patients. Optimal medical therapy to prevent post-closure myocardial infarction requires further investigation.
Assuntos
Cateterismo Cardíaco , Anomalias dos Vasos Coronários , Humanos , Masculino , Feminino , Adulto , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/terapia , Anomalias dos Vasos Coronários/cirurgia , Estudos Retrospectivos , Pessoa de Meia-Idade , Cateterismo Cardíaco/métodos , Resultado do Tratamento , Adulto Jovem , Adolescente , Angiografia Coronária , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/terapia , Fístula Vascular/cirurgia , Fístula Vascular/congênitoRESUMO
A 72-year-old male with a history of a triple-vessel coronary artery bypass graft years ago presented with a DeBakey type 2 aortic dissection and an aorto-left atrial fistula with patent bypass grafts (left internal mammary artery and saphenous vein grafts). He developed pulmonary oedema and required intubation. The right axillary artery was cannulated. After the ascending aorta and left internal mammary artery were clamped, the aorta was transected, leaving aortic tissue around two saphenous vein grafts as two separate patches. An entry tear was found adjacent to the proximal anastomosis of the saphenous vein graft to the posterior descending artery. A fistula, which was located between a false lumen in the non-coronary sinus and the dome of the left atrium, was primarily closed. Because the adventitia was thinned out in the non-coronary sinus due to aortic dissection, partial aortic root remodelling was performed with resuspension of the commissures. Hemiarch repair was performed under moderate hypothermia and unilateral antegrade cerebral perfusion. After systemic perfusion was resumed, the locations of the saphenous vein graft buttons were determined. The ascending graft was cross-clamped again; the saphenous vein graft to the obtuse marginal branch graft was reimplanted using the Carrel patch technique while a saphenous vein graft to the posterior descending artery required interposition of a 10-mm Dacron graft to accommodate the length.
Assuntos
Dissecção Aórtica , Ponte de Artéria Coronária , Átrios do Coração , Humanos , Masculino , Idoso , Átrios do Coração/cirurgia , Dissecção Aórtica/cirurgia , Dissecção Aórtica/diagnóstico , Ponte de Artéria Coronária/métodos , Ponte de Artéria Coronária/efeitos adversos , Fístula Vascular/cirurgia , Fístula Vascular/etiologia , Fístula Vascular/diagnóstico , Fístula/cirurgia , Fístula/etiologia , Fístula/diagnóstico , Reoperação/métodos , Aneurisma da Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/diagnóstico , Veia Safena/transplanteRESUMO
Cerebrospinal fluid-venous fistulas (CSFVFs) were first described in 2014 and have since become an increasingly diagnosed cause of spontaneous intracranial hypotension due to increased clinical recognition and advancements in diagnostic modalities. In this review, the authors discuss CSFVF epidemiology, the variety of clinical presentations, the authors' preferred diagnostic approach, recent advancements in diagnostic methods, treatment options, current challenges, and directions of future research.
Assuntos
Hipotensão Intracraniana , Humanos , Hipotensão Intracraniana/terapia , Hipotensão Intracraniana/diagnóstico , Hipotensão Intracraniana/diagnóstico por imagem , Veias Cerebrais/diagnóstico por imagem , Fístula Vascular/diagnóstico , Líquido CefalorraquidianoAssuntos
Ventrículos do Coração , Insuficiência da Valva Mitral , Humanos , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/cirurgia , Insuficiência da Valva Mitral/fisiopatologia , Ventrículos do Coração/diagnóstico por imagem , Fístula/diagnóstico por imagem , Fístula/complicações , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/complicações , Masculino , Diástole , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/complicações , Feminino , Vasos Coronários/diagnóstico por imagem , Pessoa de Meia-Idade , Ecocardiografia/métodosAssuntos
Embolização Terapêutica , Fístula Intestinal , Humanos , Embolização Terapêutica/métodos , Fístula Intestinal/etiologia , Fístula Intestinal/diagnóstico por imagem , Fístula Intestinal/terapia , Fístula Intestinal/cirurgia , Masculino , Fístula Vascular/terapia , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/etiologia , Resultado do Tratamento , Artéria Hepática/diagnóstico por imagem , Idoso , FemininoRESUMO
Cerebrospinal fluid venous fistulas (CSF-VFs) are an uncommon, yet increasingly recognized, cause of spontaneous intracranial hypotension.1-5 The workup involves magnetic resonance imaging (MRI) of the brain with and without contrast and MRI of the neuroaxis without contrast before dynamic myelography, either computed tomography or digital subtraction.6 The present case of an older woman with symptomatic intracranial hypotension is notable for the specific appearance of CSF-VFs on digital spinal myelography (Video 1). Among her numerous perineural cysts, it was the "disappearing" or "empty" cyst from which the fistula originated. The diagnosis was made using a second lateral fluoroscopy view, not typically used in digital spinal myelography, which demonstrated emptying of contrast from the T6 perineural cyst into the segmental vein at this level, or the "empty cyst sign." The patient then underwent transvenous onyx embolization with resolution of her orthostatic headaches and improvement of contrast-enhanced MRI of the brain with the Bern score decreasing from 7 to 0 at 3 months of follow-up.7 Because transvenous embolization of CSF-VFs is a relatively new procedure, the long-term outcomes of the procedure are not yet known.
Assuntos
Hipotensão Intracraniana , Mielografia , Humanos , Feminino , Mielografia/métodos , Hipotensão Intracraniana/diagnóstico por imagem , Hipotensão Intracraniana/terapia , Hipotensão Intracraniana/complicações , Hipotensão Intracraniana/etiologia , Embolização Terapêutica/métodos , Idoso , Imageamento por Ressonância Magnética , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/complicações , Líquido CefalorraquidianoRESUMO
An 11-year-old male neutered American bulldog was presented for evaluation of thrombocytopenia, acute onset of ataxia, and vomiting. A new murmur was auscultated on physical examination. Transthoracic echocardiographic examination revealed a bicuspid aortic valve, vegetative lesions on the aortic valve, and continuous shunting from the aortic root to the left atrium through an aorta to left atrial fistula. The dog was euthanized due to its guarded prognosis and critical condition. Pathological examination confirmed presence of a bicuspid aortic valve, aorto-left atrial fistula, and aortic infective endocarditis. Antemortem blood culture revealed two unusual organisms: Achromobacter xylosoxidans and Fusobacterium mortiferum.
Assuntos
Valva Aórtica , Doença da Válvula Aórtica Bicúspide , Doenças do Cão , Endocardite Bacteriana , Átrios do Coração , Cães , Animais , Masculino , Doenças do Cão/microbiologia , Doenças do Cão/diagnóstico por imagem , Valva Aórtica/anormalidades , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/patologia , Endocardite Bacteriana/veterinária , Endocardite Bacteriana/complicações , Endocardite Bacteriana/diagnóstico , Átrios do Coração/patologia , Átrios do Coração/anormalidades , Doença da Válvula Aórtica Bicúspide/complicações , Fístula Vascular/veterinária , Fístula Vascular/complicações , Fístula Vascular/diagnóstico por imagem , Doenças da Aorta/veterinária , Doenças da Aorta/complicações , Doenças da Aorta/diagnóstico por imagem , Doenças das Valvas Cardíacas/veterinária , Doenças das Valvas Cardíacas/complicações , Ecocardiografia/veterinária , Cardiopatias/veterinária , Cardiopatias/complicações , Fístula/veterinária , Fístula/complicações , Valvopatia Aórtica/veterinária , Valvopatia Aórtica/complicaçõesAssuntos
Fontes de Energia Elétrica , Fístula Esofágica , Corpos Estranhos , Humanos , Fístula Esofágica/etiologia , Fístula Esofágica/diagnóstico , Corpos Estranhos/complicações , Masculino , Fontes de Energia Elétrica/efeitos adversos , Doenças da Aorta/etiologia , Doenças da Aorta/diagnóstico , Lactente , Fístula Vascular/etiologia , Fístula Vascular/diagnósticoAssuntos
Fístula Biliar , Fístula Vascular , Humanos , Fístula Biliar/cirurgia , Fístula Biliar/diagnóstico por imagem , Fístula Biliar/etiologia , Fístula Biliar/diagnóstico , Fístula Vascular/diagnóstico por imagem , Veia Porta/diagnóstico por imagem , Masculino , Feminino , Pessoa de Meia-Idade , IdosoRESUMO
We describe what we believe to be the first reported case of a neonate with right coronary ostial atresia with the right coronary artery originating from the left circumflex coronary artery, in conjunction with a right coronary artery to right ventricle fistula in a patient with otherwise normal cardiac anatomy. This was found following an evaluation for a continuous murmur at 2 weeks of life with elevated troponin and abnormal electrocardiogram. Thus far the child has required no intervention and is asymptomatic at 17 months of age, but he will require long-term follow-up to monitor the size of the fistula and potential for myocardial insufficiency.
Assuntos
Anomalias dos Vasos Coronários , Sopros Cardíacos , Humanos , Sopros Cardíacos/etiologia , Recém-Nascido , Masculino , Anomalias dos Vasos Coronários/diagnóstico , Anomalias dos Vasos Coronários/complicações , Ventrículos do Coração/anormalidades , Eletrocardiografia , Fístula Vascular/complicações , Fístula Vascular/diagnóstico , Fístula Vascular/cirurgia , EcocardiografiaAssuntos
Anomalias dos Vasos Coronários , Átrios do Coração , Ultrassonografia Pré-Natal , Humanos , Átrios do Coração/anormalidades , Átrios do Coração/diagnóstico por imagem , Feminino , Gravidez , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/diagnóstico , Adulto , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/congênito , Fístula/diagnóstico por imagem , Fístula/congênitoRESUMO
INTRODUCTION: Left atrial appendage (LAA) closure (LAAC) is considered a viable alternative to anticoagulation therapy for stroke prevention in nonvalvular atrial fibrillation, we report a case with a less common shunt resulting from a device-related coronary artery-appendage fistula (CAAF) following LAAC. METHODS AND RESULTS: A 67-year-old male with a history of LAAC was referred to our emergency room with recurrent chest pain and palpitations and was diagnosed with ischemic angina pectoris. Subsequent coronary angiography (CAG) revealed 70% in-stent restenosis and an abnormal shunt of contrast originating from the left circumflex artery (LCA) to the LAA tip which did not exist before. The restenosis was successfully dilated using a drug-coated balloon, the procedure was safely completed without pericardial effusion. The patient had been implanted with a LAmbre occluder (Lifetech Scientific Corp.) in the previous LAAC procedure. This occluder had a lobe-disk design, and the distal umbrella was not fully opened after release, particularly in the lower portion. This could make the hooks embedded on the umbrella contact the LAA wall more tightly, possibly resulting in microperforation and coincidental impingement of the LCA. The epicardial adipose and hyperplastic tissue then chronically wrapped the perforated site, prevented blood outflow into the epicardium, and ultimately formed a CAAF. CONCLUSION: CAAF is a rare complication after LAAC but may be underestimated, especially for lobe-disk designed occluders. Therefore, CAG is perhaps necessary to detect this complication.
Assuntos
Apêndice Atrial , Fibrilação Atrial , Idoso , Humanos , Masculino , Apêndice Atrial/diagnóstico por imagem , Apêndice Atrial/fisiopatologia , Fibrilação Atrial/fisiopatologia , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/cirurgia , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/instrumentação , Vasos Coronários/diagnóstico por imagem , Oclusão do Apêndice Atrial Esquerdo , Desenho de Prótese , Dispositivo para Oclusão Septal/efeitos adversos , Resultado do Tratamento , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/etiologiaRESUMO
PURPOSE OF REVIEW: This review describes the presentation, diagnosis, and management of congenital coronary artery fistulas (CAFs) in adults. RECENT FINDINGS: CAFs are classified as coronary-cameral or coronary arteriovenous fistulas. Fistulous connections at the distal coronary bed are more likely to be aneurysmal with higher risk of thrombosis and myocardial infarction (MI). Medium-to-large or symptomatic CAFs can manifest as ischemia, heart failure, and arrhythmias. CAF closure is recommended when there are attributable symptoms or evidence of adverse coronary remodeling. Closure is usually achievable using transcatheter techniques, though large fistulas may require surgical ligation with bypass. Given their anatomic complexity, cardiac CT with multiplanar 3-D reconstruction can enhance procedural planning of CAF closure. Antiplatelet and anticoagulation are essential therapies in CAF management. CAFs are rare cardiac anomalies with variable presentations and complex anatomy. CAF management strategies include indefinite medical therapy, percutaneous or surgical CAF closure, and lifelong patient surveillance.
Assuntos
Anomalias dos Vasos Coronários , Humanos , Anomalias dos Vasos Coronários/terapia , Anomalias dos Vasos Coronários/diagnóstico , Anomalias dos Vasos Coronários/cirurgia , Anomalias dos Vasos Coronários/diagnóstico por imagem , Adulto , Fístula Arteriovenosa/terapia , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/diagnóstico , Fístula Arteriovenosa/cirurgia , Angiografia Coronária , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Fístula Vascular/terapia , Fístula Vascular/cirurgia , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/diagnóstico , Cateterismo Cardíaco/métodosRESUMO
A dog was presented for lameness, fever, and extreme lethargy. On physical exam, a new heart murmur, arrhythmia, and joint effusion were detected. These findings were not detected two months prior. A diagnostic work-up confirmed septic suppurative inflammation in multiple joints. Echocardiogram revealed aortic valvular endocarditis along with a communication, as a consequence of a fistula, that extended from just below the aortic sinotubular junction to the left atrial lumen. Due to a poor prognosis, humane euthanasia was elected. Necropsy and histopathology confirmed infective endocarditis of the aortic valve and an aorto-left atrial fistulous tract extending from the left coronary sinus of the aortic valve to the lumen of left atrium.