ABSTRACT
Coronary artery fistulas (CAFs) are rare vascular anomalies characterized by abnormal connections between coronary arteries and cardiac chambers or adjacent structures. Advances in cardiac interventions have led to an increasing recognition of acquired CAFs, which are typically congenital. We present a case of a 62-year-old male with a complex medical history, including hypertension, atrial fibrillation, and heart failure, who presented with exertional chest pain and palpitations. Diagnostic evaluation revealed a significant CAF originating from the right coronary artery (RCA) and terminating into the coronary sinus and right ventricle. Despite the absence of significant coronary artery occlusions, the fistula was deemed clinically significant due to its potential to cause myocardial ischemia. Management involved guideline-directed medical therapy and lifestyle modifications. This case underscores the importance of early recognition and appropriate management of CAFs to optimize patient outcomes. Further research is needed to better understand the natural history and optimal management strategies of CAFs.
ABSTRACT
Resumen La circunferencia cefálica (CC) es una medición que detecta alteraciones del crecimiento adecuado del cerebro. Las curvas de CC más utilizadas mundialmente son las propuestas por los CDC, NCHS y OMS. A pesar de las críticas sobre la metodología para crearlas, se han hecho actualizaciones para corregir inconsistencias. Esto ha servido para detectar y tratar oportunamente problemas de tamaño craneal tanto en los extremos pequeños (microcefalia) o grandes (macrocefalia). Algunos autores opinan que existe la necesidad de contar con curvas regionales para mejorar el valor diagnóstico de éstas en cada población. Otros, como Kenton Holden y colaboradores, han propuesto nuevas curvas que consolidan diferentes bases de datos con el objetivo de reducir el riesgo de errores en el diagnóstico de microcefalia o macrocefalia leve. Es necesario estudiar cuál es el patrón de crecimiento craneal normal de niños/as latinoamericanos por cada región o país, así como conocer las diferencias interétnicas.
Abstract The cephalic circumference (CC) is a measurement that detects alterations in the proper growth of the brain. CC curves most used worldwide are those proposed by the CDC, NCHS and WHO. Despite criticism of the methodology used to create them, updates have been made to correct inconsistencies, and that has helped to detect and treat on time problems of cranial size at both the small (microcephaly) and large (macrocephaly) ends. Several authors have suggested that regional reference curves should be made, and others, like Kenton Holden and colleagues, have proposed new curves that consolidate different databases, aiming to reduce the risk of errors in the diagnosis of microcephaly or mild macrocephaly. It is necessary to study what the normal cranial growth pattern of Latin American children is for each region or country, as well as to determine the interethnic differences.
