RESUMO
We present a 67-year-old male with past medical history of hyperlipidemia, hypertension, and emphysema, and who was a former smoker, with dyspnea on exertion and chest pain.
Assuntos
Artérias Brônquicas , Bronquiectasia , Doença da Artéria Coronariana , Humanos , Masculino , Idoso , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/complicações , Bronquiectasia/diagnóstico , Bronquiectasia/complicações , Bronquiectasia/etiologia , Angiografia Coronária/métodos , Doença Crônica , Vasos Coronários/diagnóstico por imagem , Fístula Artério-Arterial/diagnóstico , Fístula Artério-Arterial/complicações , Anomalias dos Vasos Coronários/diagnóstico , Anomalias dos Vasos Coronários/complicaçõesRESUMO
The incidence of acquired left internal mammary artery-to-pulmonary vein fistulas has been increasing in the last few decades. This has been attributed to the increase in coronary artery bypass surgery (CABG). The most commonly reported symptoms are angina and dyspnea. The timing of the presentation varies widely from a few months to several years after CABG. Medical management is the treatment of choice and usually controls the symptoms in most patients. Percutaneous intervention is, however, indicated when medical therapy fails. In this case report, a 72-year-old man with a history of CABG presented with progressively worsening chest pain and dyspnea. Troponin was negative and the electrocardiogram showed no acute ischemic changes. He was found to have left internal mammary artery-to-pulmonary vein fistula on coronary angiogram. His symptoms improved upon intensifications of his guideline-directed therapy for coronary artery disease. This represents an unusual cause of unstable angina.
Assuntos
Fístula Artério-Arterial , Artéria Torácica Interna , Veias Pulmonares , Idoso , Angina Instável/complicações , Fístula Artério-Arterial/diagnóstico , Fístula Artério-Arterial/etiologia , Fístula Artério-Arterial/cirurgia , Dispneia , Humanos , Masculino , Artéria Torácica Interna/cirurgia , Artéria PulmonarAssuntos
Dissecção Aórtica/etiologia , Fístula Artério-Arterial/complicações , Artéria Pulmonar/anormalidades , Dissecção Aórtica/diagnóstico , Dissecção Aórtica/cirurgia , Fístula Artério-Arterial/diagnóstico , Fístula Artério-Arterial/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/cirurgia , Tomografia Computadorizada por Raios X , Procedimentos Cirúrgicos Vasculares/métodosRESUMO
An isolated systemic artery to pulmonary vein arteriovenous fistula is a rare clinical entity. We report a 20-year-old woman diagnosed with myxomatous mitral valve prolapse with severe mitral regurgitation and planned for mitral valve repair. An aberrant aortopulmonary venous fistula was suspected intraoperatively due to flooding of the left atrium with blood from the left inferior pulmonary vein on cardiopulmonary bypass. The mitral valve was repaired successfully. A postoperative computed tomography angiogram revealed an anomalous fistula between the descending thoracic aorta and left inferior pulmonary vein. The patient underwent successful percutaneous device closure of the fistula.
Assuntos
Angiografia/métodos , Fístula Artério-Arterial/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Artéria Pulmonar/anormalidades , Tomografia Computadorizada por Raios X/métodos , Fístula Artério-Arterial/diagnóstico , Ecocardiografia , Feminino , Humanos , Período Intraoperatório , Artéria Pulmonar/cirurgia , Adulto JovemRESUMO
Fístulas de artérias coronárias têm incidência baixa, sendo diagnosticadas mais frequentemente pelo ecocardiograma ou angiotomografia coronariana, embora a cineangiocoronariografia seja o método padrão-ouro. Têm origem mais comumente na artéria coronária direita, sendo a drenagem para câmaras de baixa pressão o mais habitual. O tratamento pode ser expectante, cirúrgico ou percutâneo. Este relato descreve o caso de uma rara apresentação de insuficiência cardíaca, dada por fístula da coronária circunflexa com drenagem para o átrio esquerdo. (AU)
Coronary artery fistulas have a low incidence and are often diagnosed by echocardiography or coronary computed tomography angiography, although coronary angiography is the gold standard. They commonly originate in the right coronary artery, with drainage to low-pressure chambers being the most frequent finding. Treatment can be expectant, surgical, or percutaneous. This report describes a case of a rare presentation of heart failure due to a fistula of the circumflex coronary artery with drainage into the left atrium. (AU)
Assuntos
Humanos , Masculino , Idoso , Fístula Artério-Arterial/diagnóstico , Fístula Artério-Arterial/etiologia , Vasos Coronários/patologia , Átrios do Coração/anormalidades , Insuficiência Cardíaca/diagnóstico , Fibrilação Atrial/congênito , Cineangiografia/métodos , Ecocardiografia/métodos , Espectroscopia de Ressonância Magnética/uso terapêutico , Ecocardiografia Doppler , Fístula Artério-Arterial/diagnóstico por imagem , Eletrocardiografia/métodosRESUMO
The incidence of congenital coronary artery anomalies in the general population is low. The combination of various significant coronary artery anomalies in a single patient is not very common. We describe a case of a 20-month-old child with a unique combination of congenital coronary anomalies (atresia, stenosis, fistula) which were accurately delineated by multimodal imaging and successfully managed surgically.
Assuntos
Anormalidades Múltiplas , Fístula Artério-Arterial/diagnóstico , Estenose Coronária/diagnóstico , Anomalias dos Vasos Coronários/diagnóstico , Vasos Coronários/diagnóstico por imagem , Procedimentos Cirúrgicos Vasculares/métodos , Fístula Artério-Arterial/cirurgia , Angiografia Coronária/métodos , Estenose Coronária/cirurgia , Anomalias dos Vasos Coronários/cirurgia , Vasos Coronários/cirurgia , Ecocardiografia , Humanos , Lactente , Masculino , Tomografia Computadorizada por Raios XRESUMO
Although minimally invasive repair of pectus excavatum has been shown to have a low complication rate in large series, several case reports have documented life-threatening complications, including bleeding and cardiac perforation. We present a rare case of an arteriovenous malformation from the internal thoracic artery to the pulmonary artery caused by occlusion of the internal thoracic artery by the Nuss bar followed by an unidentified angiogenic process. The patient became symptomatic and required transcatheter coil embolization.
Assuntos
Fístula Artério-Arterial/etiologia , Tórax em Funil/cirurgia , Artéria Torácica Interna , Complicações Pós-Operatórias , Artéria Pulmonar , Toracoplastia/efeitos adversos , Toracoscopia/efeitos adversos , Adolescente , Angiografia Digital , Fístula Artério-Arterial/diagnóstico , Fístula Artério-Arterial/terapia , Embolização Terapêutica , Feminino , HumanosRESUMO
Coronary to pulmonary arterial fistula complicated with huge coronary aneurysm is a very rare condition. In this paper, we report a patient with bilateral coronary arteries to pulmonary artery fistulas with a giant coronary artery aneurysm. The patient was treated successfully by closure of the fistulas and repair of the coronary artery aneurysm with the preparation of multimodality imaging for surgery.
Assuntos
Fístula Artério-Arterial/complicações , Aneurisma Coronário/etiologia , Angiografia Coronária/métodos , Vasos Coronários/diagnóstico por imagem , Ecocardiografia/métodos , Imagem Multimodal/métodos , Artéria Pulmonar/diagnóstico por imagem , Idoso , Fístula Artério-Arterial/diagnóstico , Fístula Artério-Arterial/cirurgia , Angiografia por Tomografia Computadorizada/métodos , Aneurisma Coronário/diagnóstico , Aneurisma Coronário/cirurgia , Vasos Coronários/cirurgia , Feminino , Humanos , Período Pré-Operatório , Artéria Pulmonar/anormalidades , Artéria Pulmonar/cirurgia , Índice de Gravidade de Doença , Procedimentos Cirúrgicos Vasculares/métodosRESUMO
We report an extremely rare case of dural arteriovenous fistula(DAVF)involving the superior sagittal sinus(SSS)that presented as a primary intraventricular hemorrhage(PIVH). A 79-year-old man who presented with disturbance of consciousness and vomiting was transferred to our hospital. The initial head CT revealed an intraventricular hemorrhage in the lateral, third, and fourth ventricles, predominantly involving the right lateral ventricle associated with obstructive hydrocephalus. CT angiography and three-dimensional rotational angiography(3D-RA)revealed SSS-DAVF with retrograde venous drainage from the cortical venous system to the subependymal venous system through engorged superficial/anastomotic/deep medullary or transcerebral veins, showing a pseudophlebitic pattern. A severe stenosis of the SSS was observed at the site just proximal to the shunting point. A varix of the right transvers caudate vein(TCV)was observed within the thickest portion of the hematoma in close contact with the wall of the right lateral ventricle. A stenosis of the branching point of the right TCV was detected on the 3D-RA image. The DAVF was completely cured after transarterial embolization. The varix gradually shrank and finally disappeared after 2 months. This is the first report of a case of PIVH due to SSS-DAVF with a subependymal varix considered as the bleeding point. Serial gadolinium-enhanced MR images clearly showed the shrinking of the varix. Our case is the second reported case of spontaneous resolution of the varix after embolization of the DAVF. The obstructive changes of the two venous outflow pathways(SSS/TCV)might further worsen the state of venous congestion in the deep medullary venous system and eventually lead to formation and rupture of the varix.
Assuntos
Fístula Artério-Arterial , Malformações Vasculares do Sistema Nervoso Central , Hemorragia Cerebral , Embolização Terapêutica , Idoso , Fístula Artério-Arterial/complicações , Fístula Artério-Arterial/diagnóstico , Malformações Vasculares do Sistema Nervoso Central/complicações , Malformações Vasculares do Sistema Nervoso Central/diagnóstico , Hemorragia Cerebral/etiologia , Humanos , Masculino , Procedimentos Neurocirúrgicos , Seio Sagital SuperiorAssuntos
Fístula Artério-Arterial/diagnóstico , Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Anomalias dos Vasos Coronários/diagnóstico , Imageamento Tridimensional/métodos , Artéria Pulmonar/anormalidades , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/diagnóstico por imagemRESUMO
We report the case of a 14-year-old female who had tetralogy of Fallot along with anomalous origin of the left pulmonary artery from the ascending aorta with co-dominant double aortic arch forming a complete vascular ring compressing the oesophagus along with a left main coronary artery to right ventricular outflow tract fistula. She underwent surgical correction without conduit placement.
Assuntos
Aorta/anormalidades , Fístula Artério-Arterial/diagnóstico , Anomalias dos Vasos Coronários/diagnóstico , Artéria Pulmonar/anormalidades , Tetralogia de Fallot/diagnóstico , Adolescente , Fístula Artério-Arterial/congênito , Fístula Artério-Arterial/cirurgia , Procedimentos Cirúrgicos Cardíacos , Angiografia por Tomografia Computadorizada , Anomalias dos Vasos Coronários/cirurgia , Feminino , Humanos , Imageamento Tridimensional , Tetralogia de Fallot/cirurgia , Procedimentos Cirúrgicos VascularesRESUMO
Coronary-pulmonary artery fistula is a rare anomaly in which an aortopulmonary collateral artery arises from a coronary artery, often seen in patients with pulmonary atresia with ventricular septal defect. In the presented case, a coronary-pulmonary artery fistula arose from the left main coronary artery and supplied blood flow to a left upper lobe segment. The life-sized three-dimensional printed model was helpful in pre-surgical planning for unifocalisation of the aortopulmonary collateral arteries.
Assuntos
Fístula Artério-Arterial/cirurgia , Vasos Coronários/cirurgia , Impressão Tridimensional , Artéria Pulmonar/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Fístula Artério-Arterial/congênito , Fístula Artério-Arterial/diagnóstico , Cateterismo Cardíaco , Vasos Coronários/diagnóstico por imagem , Feminino , Humanos , Recém-Nascido , Artéria Pulmonar/diagnóstico por imagemRESUMO
Epicardial surgical repair has been proven to be effective for patients with coronary- pulmonary artery fistula (CPAF). However, most of the surgery has been performed through a median sternotomy under cardiopulmonary bypass. In this report, we describe a novel technique of performing minimally invasive surgery for CPAF patients without extracorporeal circulation via a parasternal minithoracotomy. This technique has proved to be safe and effective and may be worthy of use for patients with CPAF.
Assuntos
Fístula Artério-Arterial/cirurgia , Vasos Coronários/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Artéria Pulmonar/cirurgia , Esterno/cirurgia , Toracotomia/métodos , Procedimentos Cirúrgicos Vasculares/métodos , Fístula Artério-Arterial/diagnóstico , Angiografia Coronária , Vasos Coronários/diagnóstico por imagem , Ecocardiografia Transesofagiana , Humanos , Artéria Pulmonar/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
A 44-year-old man was admitted to our hospital with chest pain. We diagnosed him with pericardial effusion collection because of a spontaneous ruptured coronary aneurysm of 1.5 cm with coronary pulmonary arterial fistula (CPAF) by enhanced computed tomography and angiography. We completely resected the ruptured aneurysm and safely closed the CPAF. Rupture of coronary aneurysms with CPAF is rare, especially tiny aneurysms. In previous reports, most cases were older women and the diameter of the ruptured aneurysms was greater than 3.0 cm. We report a case of a middle-aged man with a tiny ruptured coronary aneurysm with CPAF.
Assuntos
Aneurisma Roto/diagnóstico , Fístula Artério-Arterial/diagnóstico , Aneurisma Coronário/diagnóstico , Adulto , Aneurisma Roto/complicações , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/cirurgia , Fístula Artério-Arterial/complicações , Fístula Artério-Arterial/diagnóstico por imagem , Fístula Artério-Arterial/cirurgia , Aneurisma Coronário/complicações , Aneurisma Coronário/diagnóstico por imagem , Aneurisma Coronário/cirurgia , Angiografia Coronária , Diagnóstico Diferencial , Humanos , Masculino , Derrame Pericárdico/etiologia , Tomografia Computadorizada por Raios XAssuntos
Fístula Artério-Arterial/diagnóstico , Doença da Artéria Coronariana/diagnóstico , Comunicação Interatrial/diagnóstico , Idoso , Fístula Artério-Arterial/cirurgia , Ponte de Artéria Coronária/métodos , Doença da Artéria Coronariana/cirurgia , Seio Coronário , Diagnóstico Diferencial , Ecocardiografia Doppler , Humanos , MasculinoRESUMO
Giant coronary artery aneurysm (GCAA) combined with coronary artery fistula to the pulmonary artery (PA) is rare. A 79-year-old man was accidentally discovered with GCAA. He was operated on by use of aneurysmorrhaphy, and closure of the fistulae was performed. Because ischemic changes appeared, coronary artery bypass grafting was done. The postoperative course was uneventful, and the patient was discharged on postoperative day 14. We report here a case of GCAA with a size of 66 × 52 mm in diameter associated with a fistula formation into the PA. It is one of the largest sizes of GCAA that has occurred after fistula formation.