RESUMO
Coronary artery fistula (CAF) is characterized as a congenital or acquired abnormal communication between a coronary artery and any of the four chambers of the heart (coronary-cameral fistula) or great vessels (coronary arteriovenous fistula) bypassing the capillaries within myocardium. CAF is a rare disease, challenging to diagnose and treat depending on the anatomical location and type of the fistula and accompanying diseases. This study aims to report a case with multiple coronary artery to coronary sinus (CS) fistulas with giant left circumflex artery and multivalvular infective endocarditis.
Assuntos
Fístula Arteriovenosa , Doença da Artéria Coronariana , Seio Coronário , Anomalias dos Vasos Coronários , Endocardite Bacteriana , Endocardite , Humanos , Seio Coronário/diagnóstico por imagem , Seio Coronário/cirurgia , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/cirurgia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana/cirurgia , Doença da Artéria Coronariana/complicações , Endocardite/complicações , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/cirurgiaAssuntos
Anomalias dos Vasos Coronários , Doenças Vasculares , Doenças Vasculares/congênito , Humanos , Feminino , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Doenças Vasculares/diagnóstico , Doenças Vasculares/etiologia , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/complicações , Angiografia Coronária/efeitos adversosAssuntos
Angiografia Coronária , Humanos , Angiografia Coronária/métodos , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/diagnóstico , Masculino , Vasos Coronários/diagnóstico por imagem , Infarto do Miocárdio/terapia , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/complicações , Pessoa de Meia-Idade , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/terapiaAssuntos
Angiografia Coronária , Anomalias dos Vasos Coronários , Humanos , Angiografia Coronária/métodos , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Masculino , Angiografia por Tomografia Computadorizada , Feminino , Pessoa de Meia-IdadeRESUMO
We describe herein a case of a 16 years-old female patient referred to our department for further exploration of a chest pain. Color Doppler echocardiography revealed an abnormal flow at the level of the pulmonary artery. Exercise testing was abnormal leading to further imaging including computed cardiac tomography followed by coronary angiography which showed anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) associated with mid shaft left main stenosis. We discuss this uncommon association and therapeutic options.
Assuntos
Estenose Coronária , Anomalias dos Vasos Coronários , Humanos , Feminino , Adolescente , Artéria Pulmonar/diagnóstico por imagem , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Angiografia Coronária , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/etiologiaAssuntos
Doença da Artéria Coronariana , Anomalias dos Vasos Coronários , Fístula , Cardiopatias Congênitas , Humanos , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia , Artéria Pulmonar/anormalidades , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/cirurgia , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/cirurgia , Angiografia CoronáriaRESUMO
Anomalous left coronary artery originating from the pulmonary artery (ALCAPA) is an infrequent congenital anomaly. Presentation of this syndrome is rare in adults. Nevertheless, adult patients are at risk of ischaemia, arrhythmias or sudden cardiac death and always require surgical intervention. At our institution, a specific technique of interposition of the right internal iliac artery as a free-graft for left coronary artery reimplantation was used in adult ALCAPA patients. The aim of this report is to determine long-term results and experiences with this surgical technique.
Assuntos
Artéria Coronária Esquerda Anormal , Síndrome de Bland-White-Garland , Anomalias dos Vasos Coronários , Adulto , Humanos , Síndrome de Bland-White-Garland/cirurgia , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia , Artéria Pulmonar/anormalidades , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/cirurgia , Reimplante , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/cirurgiaRESUMO
BACKGROUND: Coronary artery complications (CACs) in patients who undergoing prosthetic pulmonary valve implantation for congenital heart disease can lead to fetal outcomes. However, the incidence of and risk factors for CACs in these patients remain unknown.MethodsâandâResults: A retrospective cohort study was conducted on patients who underwent cardiac computed tomography or invasive coronary angiography after prosthetic pulmonary valve implantation at Seoul National University Hospital from June 1986 to May 2021. Among 341 patients, 25 (7.3%) were identified with CACs, and 2 of them died. Among the patients with CACs, congenital coronary anomalies and an interarterial course of the coronary artery were identified in 11 (44%) and 18 (72%) patients, respectively. Interarterial and intramural courses of the coronary artery were associated with a 4.4- and 10.6-fold increased risk of CACs, respectively. Among patients with tetralogy of Fallot and pulmonary atresia, the aortic root was rotated further clockwise in patients with coronary artery compression compared to those without it (mean [±SD] 128.0±19.9° vs. 113.5±23.7°; P=0.024). The cut-off rotation angle of the aorta for predicting the occurrence of coronary artery compression was 133°. CONCLUSIONS: Perioperative coronary artery evaluation and prevention of CACs are required in patients undergoing prosthetic pulmonary valve implantation, particularly in those with coronary artery anomalies or severe clockwise rotation of the aortic root.
Assuntos
Valva Pulmonar , Humanos , Estudos Retrospectivos , Feminino , Masculino , Fatores de Risco , Adulto , Valva Pulmonar/cirurgia , Valva Pulmonar/diagnóstico por imagem , Implante de Prótese de Valva Cardíaca/efeitos adversos , Cardiopatias Congênitas/cirurgia , Doença da Artéria Coronariana/etiologia , Doença da Artéria Coronariana/cirurgia , Doença da Artéria Coronariana/diagnóstico por imagem , Angiografia Coronária , Adolescente , Adulto Jovem , Próteses Valvulares Cardíacas/efeitos adversos , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/complicações , Incidência , Criança , Pessoa de Meia-Idade , Tetralogia de Fallot/cirurgiaRESUMO
This imaging observation underscores a rare single coronary artery anomaly, wherein the right coronary artery originates from the left anterior descending artery (LAD). The stenosis in the proximal LAD adds complexity, emphasizing the need for multidisciplinary evaluation and decision-making.
Assuntos
Doença da Artéria Coronariana , Anomalias dos Vasos Coronários , Humanos , Constrição Patológica , Angiografia Coronária , Anomalias dos Vasos Coronários/diagnóstico por imagemRESUMO
Spontaneous Coronary Artery Dissection (SCAD) is a significant cause of acute coronary syndrome. SCAD frequently affects young women, often without cardiovascular risk factors. Coronary angiography is the diagnostic mode of choice. Based on clinical context, treatment is divided into conservative methods and revascularization with either percutaneous coronary intervention or bypass grafting. This case report describes a 26-year-old female with a preceding diagnosis of myopericarditis who presented to the ED with inferior STEMI and was subsequently diagnosed with a spontaneous right coronary artery dissection.
Assuntos
Anomalias dos Vasos Coronários , Intervenção Coronária Percutânea , Doenças Vasculares , Doenças Vasculares/congênito , Humanos , Feminino , Adulto , Fatores de Risco , Vasos Coronários , Estudos Retrospectivos , Doenças Vasculares/diagnóstico , Doenças Vasculares/diagnóstico por imagem , Intervenção Coronária Percutânea/métodos , Anomalias dos Vasos Coronários/diagnóstico , Anomalias dos Vasos Coronários/diagnóstico por imagem , Angiografia Coronária/efeitos adversosRESUMO
PURPOSE OF REVIEW: Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndrome (ACS), particularly among women < 50 years of age. Here, we aim to review the pathogenesis of SCAD, discuss SCAD as an initial manifestation of systemic arterial disease, and highlight invasive strategies as well as unique challenges in the care of women with SCAD. RECENT FINDINGS: A paradigm shift has occurred in the care of SCAD patients in the past decade as recommendations for conservative management have become widespread. Invasive interventions are reserved for patients with hemodynamic compromise or active ischemia due to increased periprocedural complications and failure rates. Certain patient populations have been identified for larger territory infarcts and proximal disease including patients with known connective tissue disease, premenopausal women, and patients with pregnancy-associated SCAD (P-SCAD). Current recommended management of SCAD is conservative. Despite a growing awareness of SCAD and its known association with systemic arteriopathies in women, evidence-based data remains scarce. Future studies focused on identifying genetic factors, optimal medical therapy after SCAD, and techniques to minimize interventional complications are needed.
Assuntos
Anomalias dos Vasos Coronários , Doenças Vasculares , Doenças Vasculares/congênito , Gravidez , Humanos , Feminino , Fatores de Risco , Vasos Coronários , Angiografia Coronária/métodos , Doenças Vasculares/etiologia , Doenças Vasculares/terapia , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/terapiaAssuntos
Anomalias dos Vasos Coronários , Vasos Coronários , Humanos , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Tomografia Computadorizada por Raios X , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia , Artéria Pulmonar/anormalidades , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/cirurgiaRESUMO
BACKGROUND: Coronary artery fistula (CAF) is a rare coronary anomaly. This study aimed to investigate the prevalence, clinical features, and imaging characteristics of CAF among patients undergoing coronary angiography (CAG). METHOD: This was a retrospective study including 20 259 consecutive patients (12 458 were male) who underwent CAG at our institution from September 2018 to March 2023. Electronic angiography records were reviewed, and a total of 86 (0.42%) CAF patients were enrolled and analyzed. RESULT: Of the 86 CAF patients, 42 (49%) were male. Thus, the prevalence of CAF for males and females was 0.34% and 0.56%, respectively. Arrhythmia, left ventricular (LV) hypertrophy, LV dilation, and LV systolic dysfunction were observed in 38, 25, 10 and 5 cases, respectively. Among the 86 CAF patients, a total of 117 CAFs were detected. 61 (71%) patients had a single CAF, and the remaining 25 (29%) patients had multiple CAFs. Of the 117 CAFs, the most common origins and terminations were the left anterior descending artery (nâ =â 50) and the pulmonary artery (nâ =â 73), respectively. The CAF diameters were greatly varied, ranging from unmeasurable to 7.8â mm, and 22 (18%) CAFs were larger than 3â mm. CONCLUSION: In the present study, the prevalence of CAF was 0.42% with a female predilection. Arrhythmia, LV remodeling and dysfunction were common. Seventy-one percent of patients had a single CAF. The left anterior descending artery and the pulmonary artery were the most common origin and termination of CAFs, respectively. Most CAFs were small, and 18% of CAFs were larger than 3â mm.
Assuntos
Doença da Artéria Coronariana , Anomalias dos Vasos Coronários , Fístula , Humanos , Masculino , Feminino , Angiografia Coronária/métodos , Prevalência , Estudos Retrospectivos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/epidemiologia , Arritmias Cardíacas , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/epidemiologiaAssuntos
Anomalias dos Vasos Coronários , Insuficiência da Valva Mitral , Feminino , Humanos , Lactente , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia , Artéria Pulmonar/anormalidades , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/cirurgia , Função Ventricular Esquerda , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Resultado do Tratamento , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/cirurgiaRESUMO
We describe the case of a newborn male with a large fistula from the left main coronary artery to the right ventricle. This case illustrates a rare congenital coronary artery fistula and its successful surgical management in the neonatal period.