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1.
Rev Med Liege ; 74(12): 625-626, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31833270

RESUMO

Congenital coronary artery fistulas are infrequent but sometimes hemodynamically important anomalies depending on their magnitude and the cardiac chamber or vascular site involved. Fistula from left circumflex artery to coronary sinus are potentially curable causes of ischemic heart disease.


Assuntos
Doença da Artéria Coronariana , Anomalias dos Vasos Coronários , Fístula Vascular , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/cirurgia , Seio Coronário , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/cirurgia , Humanos , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/cirurgia
2.
Medicine (Baltimore) ; 98(51): e18303, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860979

RESUMO

RATIONALE: Aortoesophageal fistula (AEF) is the direct communication between the aorta and esophagus, which can cause fatal hemorrhage, and its incidence increased with the use of an esophageal stent (ES). PATIENT CONCERNS: A 79-year-old man was admitted due to hemodynamic shock with massive hematemesis caused by AEF 1 month after the implantation of an ES. DIAGNOSES: Computed tomography angiography visualized an AEF with an ulcer-like projection on the aortic arch where the ES was placed. Angiography of the aorta revealed extravasation of contrast media from the aortic arch into the stented esophagus, which confirmed the diagnosis. INTERVENTIONS: Thoracic endovascular aortic repair (TEVAR) was performed for massive hematemesis caused by ES-related, AEF but did not solve the underlying problem, leading to the second fatal hemorrhage. LESSONS: TEVAR for the unique treatment of ES-related AEF is feasible in certain cases but may lead to collapse after a specific period.


Assuntos
Doenças da Aorta/complicações , Fístula Esofágica/complicações , Hemorragia Gastrointestinal/etiologia , Implantação de Prótese/efeitos adversos , Stents/efeitos adversos , Fístula Vascular/complicações , Idoso , Doenças da Aorta/etiologia , Doenças da Aorta/cirurgia , Angiografia por Tomografia Computadorizada , Fístula Esofágica/etiologia , Fístula Esofágica/cirurgia , Evolução Fatal , Hemorragia Gastrointestinal/cirurgia , Humanos , Masculino , Tomografia Computadorizada por Raios X , Fístula Vascular/etiologia , Fístula Vascular/cirurgia
3.
Zentralbl Chir ; 144(5): 471-481, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31634972

RESUMO

INTRODUCTION: Circuits of abdominal arteries to adjoining lumenal organs, especially in triggering circumstances, are rare diseases that are increasingly evident in endovascular therapies and complex viscero-/tumor-surgical procedures with subsequent lengthy adjuvant therapies. Their care is a challenge and involves frequent complications and mortality. METHOD: Narrative overview on the basis of current scientific references and our clinical and surgical experience. RESULTS: Uretero-arterial fistulas are usually associated with recurrent and intermittent gross haematuria. The diagnostic test of choice continues to be angiography with the potential for endovascular therapy, which has displaced open surgical procedures due to minimal invasiveness, low morbidity and mortality. Aorto-oesophageal fistulas may result from underlying infectious and malignant diseases as well as open and endovascular therapies of the aorta. Multi-line contrast CT of the thorax/abdomen and gastroscopy have priority in diagnostic testing. Endovascular procedures can only be understood as bridging procedures, and only the removal of prostheses with aortic and gastrointestinal reconstruction are curative. Aorto-enteric fistulas are secondary complications of open and endovascular aortic surgery. Contrast enhanced multi-line CT has high sensitivity and specificity. In contrast, open surgical therapy involves in-situ reconstruction of extra-anatomical reconstructions with aortic ligature. Endovascular therapy is reserved for exceptional cases. Inflammatory aneurysms of visceral arteries may be associated with adjacent inflammatory processes, most commonly pseudoaneurysms. The most suitable diagnostic procedure is contrast-enhanced thin-film CT angiography. The treatment of choice is endovascular ablation using covered stents or embolisation. CONCLUSION: Arterio-visceral/arterio-lumenal fistulas are similar in pathogenesis, predisposing factors and clinical symptoms. An interdisciplinary consultation is employed to identify individualised therapy. Endovascular/interventional procedures are safe and effective, and open surgical rehabilitation is mostly curative.


Assuntos
Falso Aneurisma , Doenças da Aorta , Implante de Prótese Vascular , Procedimentos Endovasculares , Fístula Vascular , Doenças da Aorta/terapia , Humanos , Stents , Resultado do Tratamento , Fístula Vascular/cirurgia
5.
Hinyokika Kiyo ; 65(7): 299-303, 2019 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-31501396

RESUMO

We report a case of right uretero-external iliac artery fistula. A 46-year-old woman diagnosed with left ovarian cancer with peritoneal dissemination underwent simple hysterectomy, bilateral adnexal removal, partial omentectomy and appendectomy. Sixteen months after the operation, a computed tomography scan showed right hydronephrosis due to the development of tumor within the pelvis. A ureteral stent was placed into the right ureter in order to preserve renal function. The ureteral stent was replaced at regular intervals. Five months after the ureteral stent placement, the patient was hospitalized urgently with gross hematuria. She was diagnosed with right uretero-external iliac artery fistula based on the angiographic examination that was conducted to detect the source of hemorrhage. She was treated successfully with endovascular stent grafting in the right external iliac artery. She has since shown no episode of hematuria.


Assuntos
Stents , Doenças Ureterais , Fístula Urinária , Fístula Vascular , Feminino , Humanos , Artéria Ilíaca , Pessoa de Meia-Idade , Doenças Ureterais/cirurgia , Fístula Urinária/cirurgia , Fístula Vascular/cirurgia
6.
J Vet Cardiol ; 24: 78-84, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31405558

RESUMO

This report describes a rare case of an aorto-cardiac fistula in a six-year-old French Warmblood mare presented with atrial fibrillation, decreased performance, ventral oedema, bounding arterial pulsation and pathological jugular venous pulse. A 2.7-cm-diameter fistula connected the right aortic sinus of Valsalva to the right atrium. Atrial fibrillation was likely due to volume overload of the right heart due to left-to-right shunting. The horse was treated by percutaneous transcatheter closure of the fistula delivered under general anaesthesia using a transarterial approach. The operation was initially successful, and clinical signs of congestive heart failure improved immediately. However, the device dislodged six days after procedure, and the general condition of the horse deteriorated quickly. A second closure attempt to deliver the occluder using a transvenous approach in the standing horse failed, and the horse was eventually euthanized. Procedural aspects and several possible risk factors for device dislodgement are discussed.


Assuntos
Átrios do Coração , Doenças dos Cavalos/cirurgia , Seio Aórtico , Fístula Vascular/veterinária , Animais , Fibrilação Atrial/etiologia , Fibrilação Atrial/veterinária , Cateterismo Cardíaco , Feminino , Cavalos , Fístula Vascular/complicações , Fístula Vascular/cirurgia
8.
Khirurgiia (Mosk) ; (6): 101-106, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31317948

RESUMO

Aorto-esophageal and aorto-bronchial fistulas are rare and life-threatening diseases if emergency treatment is absent. The most of publications devoted to this problem are case reports describing successful treatment of patients with aorto-esophageal and aorto-bronchial fistulas by using of endovascular or open transthoracic surgery. However, we did not find reports of several aortic fistulas in a patient after previous aortic stenting. It is presented case report of patient with aorto-esophago-bronchial and aorto-pulmonary fistulas in postoperative period after thoracic endovascular aortic repair (TEVAR).


Assuntos
Aneurisma da Aorta Torácica/cirurgia , Fístula Brônquica/etiologia , Procedimentos Endovasculares/efeitos adversos , Fístula Esofágica/etiologia , Pneumopatias/etiologia , Fístula Vascular/etiologia , Aneurisma da Aorta Torácica/complicações , Doenças da Aorta/etiologia , Doenças da Aorta/cirurgia , Fístula Brônquica/cirurgia , Procedimentos Endovasculares/métodos , Fístula Esofágica/cirurgia , Humanos , Pneumopatias/cirurgia , Fístula do Sistema Respiratório/etiologia , Fístula do Sistema Respiratório/cirurgia , Fístula Vascular/cirurgia
10.
Intern Med ; 58(20): 3025-3028, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31243231

RESUMO

A 63-year-old man had received chemoradiotherapy 7 years ago for stage IIIA pulmonary adenocarcinoma of the left lower lobe and stereotactic irradiation 3 years ago for stage IA pulmonary squamous cell carcinoma of the left upper lobe. An esophageal stent was placed because of esophageal narrowing caused by tumor invasion. Five months later, he was diagnosed with an aortoesophageal fistula. Because invasive surgery posed challenges, thoracic endovascular aortic repair (TEVAR) was performed. We report this rare case of aortoesophageal fistula treated using TEVAR. However, the therapeutic effect was temporary. Further studies investigating the indications for TEVAR are warranted.


Assuntos
Aorta Torácica , Doenças da Aorta/etiologia , Procedimentos Endovasculares/métodos , Fístula Esofágica/etiologia , Neoplasias Pulmonares/terapia , Fístula Vascular/etiologia , Doenças da Aorta/diagnóstico , Doenças da Aorta/cirurgia , Quimiorradioterapia , Fístula Esofágica/diagnóstico , Fístula Esofágica/cirurgia , Humanos , Neoplasias Pulmonares/complicações , Masculino , Pessoa de Meia-Idade , Stents , Tomografia Computadorizada por Raios X , Fístula Vascular/diagnóstico , Fístula Vascular/cirurgia
11.
Echocardiography ; 36(6): 1191-1193, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31206792

RESUMO

A 59-year-old woman with episodes of chest pain was diagnosed with cardiac myxoma. Transesophageal echocardiography (TEE) showed a massive vascularized tumor and there was a blood stream spurting from the internal cavity of tumor into left atrium through an interconnected sinus tract. Coronary artery angiography (CAG) indicated that the mass was enhanced upon the administration of contrast media, which spouted into the cardiac chamber. This is the first case to report the development of the coronary artery steal syndrome due to hemorrhage and associated fistula formation in a left atrial myxoma, which was detected by TEE and confirmed by CAG.


Assuntos
Doença da Artéria Coronariana/etiologia , Neoplasias Cardíacas/complicações , Hemorragia/etiologia , Mixoma/complicações , Fístula Vascular/etiologia , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/cirurgia , Ecocardiografia Transesofagiana/métodos , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/cirurgia , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/cirurgia , Hemorragia/diagnóstico por imagem , Hemorragia/cirurgia , Humanos , Pessoa de Meia-Idade , Mixoma/diagnóstico por imagem , Mixoma/cirurgia , Síndrome , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/cirurgia
12.
Tex Heart Inst J ; 46(2): 133-135, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31236080

RESUMO

Aortoventricular fistula, a rare congenital or acquired defect of the aortic wall, is characterized by an abnormal connection between the aorta and one of the ventricles. Symptom severity correlates with the diameter of the fistula and with the acute or chronic timing of presentation. The diagnosis is usually made by using echocardiography, and surgical treatment is necessary to avoid progression to heart failure. We describe the case of a 27-year-old woman who underwent successful surgical repair of an aortoventricular fistula that originated from the right coronary sinus and extended into the left ventricle through the interventricular septum. In addition to the patient's case, we briefly discuss this unusual condition.


Assuntos
Aorta Torácica , Procedimentos Cirúrgicos Cardíacos/métodos , Cardiopatias/cirurgia , Ventrículos do Coração , Fístula Vascular/cirurgia , Adulto , Ecocardiografia Transesofagiana , Feminino , Fístula/diagnóstico , Fístula/cirurgia , Cardiopatias/diagnóstico , Humanos , Fístula Vascular/diagnóstico
13.
BMJ Case Rep ; 12(5)2019 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-31068354

RESUMO

A 78-year-old man attended for outpatient capsule endoscopy, to investigate a recent history of unexplained small bowel bleeding. His previous medical history included an abdominal aortic aneurysm repair 6 years ago. Soon after capsule ingestion, he experienced sudden onset abdominal pain and collapsed on hospital grounds. He was rapidly transferred to the emergency department as he was haemodynamically unstable, and a significant per rectum (PR) bleed was found on examination. The patient was quickly stabilised following fluid resuscitation. CT angiography was performed which did not show active bleeding. However, use of the real-time capsule viewer indicated a profuse active jejunal bleed originating from the aortic graft, suggestive of an aortoenteric fistula. The patient underwent emergency endovascular cuff placement, and subsequent endovascular abdominal aortic stent grafting, to good effect.


Assuntos
Dor Abdominal/diagnóstico por imagem , Aorta Abdominal/patologia , Endoscopia por Cápsula/efeitos adversos , Hemorragia Gastrointestinal/diagnóstico por imagem , Fístula Intestinal/patologia , Fístula Vascular/patologia , Idoso , Aorta Abdominal/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Tratamento de Emergência , Hemorragia Gastrointestinal/patologia , Hemorragia Gastrointestinal/cirurgia , Humanos , Fístula Intestinal/diagnóstico por imagem , Fístula Intestinal/cirurgia , Masculino , Stents , Resultado do Tratamento , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/cirurgia , Procedimentos Cirúrgicos Vasculares
14.
Ann Vasc Surg ; 60: 475.e5-475.e10, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31075467

RESUMO

Innominate artery pathology is traditionally treated with open surgical repair and is associated with significant morbidity. No dedicated endovascular solution exists for this anatomic location. We report a series of 3 cases of successful management of innominate artery injuries using an off-label, modified Zenith ESLE stent graft (Cook Medical, Bloomington, IN). Two patients presented with pseudoaneurysms after attempted central venous catheterization, and 1 patient developed a tracheo-innominate fistula. Access was obtained in a retrograde fashion via the right common carotid artery in 2 cases, and via the right axillary artery in the other. Additional anatomic considerations included a prior sternotomy in 2 cases and a bovine arch in 2 cases. Due to the emergent nature of the cases, no cerebral protection maneuvers were taken. The ESLE limbs are of uniform diameter with 3 Z-stent wireforms and measure 55 mm in length. Removal of the distal stent reduces the length to 38 mm. Fourteen- to 18-mm diameter grafts were used. All 3 cases resulted in technical success with complete exclusion of the defect. There were no new neurologic deficits and all patients recovered uneventfully. This approach represents an effective off-label solution for what frequently presents as an emergent problem. In 2 cases, it obviated the need for a complicated redo sternotomy and facilitated endovascular repair in a vessel for which there was no indicated off-the-shelf conduit. Modification of existing devices successfully addressed the need for a nontapered graft of short length and moderate vessel diameter and allowed for minimally invasive treatment of anatomically complex pathology.


Assuntos
Falso Aneurisma/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Tronco Braquiocefálico/cirurgia , Procedimentos Endovasculares/instrumentação , Fístula do Sistema Respiratório/cirurgia , Traqueia , Fístula Vascular/cirurgia , Lesões do Sistema Vascular/cirurgia , Idoso de 80 Anos ou mais , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Tronco Braquiocefálico/diagnóstico por imagem , Tronco Braquiocefálico/lesões , Cateterismo Venoso Central/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Fístula do Sistema Respiratório/diagnóstico por imagem , Fístula do Sistema Respiratório/etiologia , Traqueia/diagnóstico por imagem , Traqueia/lesões , Traqueostomia/efeitos adversos , Resultado do Tratamento , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/etiologia , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologia
15.
J Coll Physicians Surg Pak ; 29(6): S68-S69, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31142428

RESUMO

In situ reconstruction using femoral veins is emerging as one of the acceptable options for aortic reconstruction in patients with aortoduodenal fistula. We report a 35-year young male who presented with secondary aortoenteric fistula. His infected aortic graft was removed and was successfully managed by neo-aortic reconstruction, using both femoral veins in a 'pantaloon' fashion. He had smooth postoperative recovery and did not have graft re-infection. He did not show signs of chronic venous insufficiency on long-term follow-up.


Assuntos
Aorta Abdominal/patologia , Doenças da Aorta/diagnóstico , Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Veia Femoral/transplante , Fístula Intestinal/diagnóstico , Fístula Intestinal/cirurgia , Fístula Vascular/diagnóstico , Fístula Vascular/cirurgia , Adulto , Aorta Abdominal/cirurgia , Biópsia , Remoção de Dispositivo , Duodenopatias/cirurgia , Humanos , Fístula Intestinal/microbiologia , Masculino , Complicações Pós-Operatórias , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/cirurgia , Reoperação , Resultado do Tratamento , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/microbiologia
16.
Ann Vasc Surg ; 59: 314.e1-314.e4, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31009726

RESUMO

Secondary stent graft infection is a life-threatening complication after thoracic endovascular aortic repair (TEVAR). There is no consensus on optimal treatment strategy, but combined antibiotic and surgical treatment is advocated. Two years after his TEVAR procedure, a 70-year-old patient was admitted to the hospital with a secondary periaortic abscess. At first, the abscess was managed with clindamycin and transesophageal drainage. The abscess would not dissipate, and an infected iatrogenic aortoesophageal fistula was formed, which was surgically treated with esophageal resection, gastric tube reconstruction, and omental flap coverage.


Assuntos
Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/efeitos adversos , Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Fístula Esofágica/cirurgia , Esofagectomia , Omento/cirurgia , Infecções Relacionadas à Prótese/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Stents/efeitos adversos , Retalhos Cirúrgicos , Fístula Vascular/cirurgia , Idoso , Antibacterianos/uso terapêutico , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aortografia/métodos , Implante de Prótese Vascular/instrumentação , Angiografia por Tomografia Computadorizada , Drenagem/instrumentação , Procedimentos Endovasculares/instrumentação , Fístula Esofágica/diagnóstico por imagem , Fístula Esofágica/microbiologia , Humanos , Doença Iatrogênica , Masculino , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/microbiologia , Resultado do Tratamento , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/microbiologia
17.
Am J Emerg Med ; 37(7): 1394.e3-1394.e4, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31003830

RESUMO

A 58-year-old woman presented with gum bleeding, hematuria, and cutaneous ecchymoses. Left hip replacement had been performed five years prior. The overall findings of our work-up were consistent with ongoing DIC triggered by the presence of an arterio-venous left femoral fistula. The patient was treated successfully with fresh frozen plasma, the fistula was surgically repaired and a stent was placed. On the second day, bleeding had resolved and laboratory values reverted to normal. This uncommon scenario is reminiscent of the Kasabach-Merritt syndrome and well illustrates that patients with an arterio-venous fistula can sometimes present with atypical features. The Kasabach-Merritt syndrome is reported in pediatric and adult patients with giant hemangiomas and angiosarcomas. Adult cases are described also in association with hematomas and large vascular aneurysms. The underlying pathophysiology is the sequestration and consumption of platelets and clotting factors with uncontrolled formation of microthrombi within the vascular lesion. DIC and a microangiopathic hemolytic anemia can subsequently develop. Mechanistic pathways of the Kasabach-Merritt syndrome in the context of a vascular fistula are shared with the more common causes of the syndrome. We speculate that the endothelial dysfunction and injury caused by the flow shear were the pivotal triggers of the aberrant trapping of platelets, the consumptive coagulopathy, and the formation of microthrombi within the fistula. Mortality rate can be as high as up to 40%. The Kasabach-Merritt syndrome could represent the only clinical feature of an otherwise occult vascular fistula. Emergency physicians should be aware of this condition.


Assuntos
Coagulação Intravascular Disseminada/diagnóstico , Síndrome de Kasabach-Merritt/diagnóstico , Fístula Vascular/diagnóstico , Angiografia , Coagulação Intravascular Disseminada/etiologia , Feminino , Humanos , Síndrome de Kasabach-Merritt/etiologia , Pessoa de Meia-Idade , Fístula Vascular/complicações , Fístula Vascular/cirurgia
19.
Ann Vasc Surg ; 59: 309.e11-309.e14, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30825509

RESUMO

Secondary aortobronchial fistula (ABF) is an uncommon clinical entity associated with increased mortality. Most common presentation is hemoptysis, ranging from repetitive self-limiting episodes to massive hematemesis. Mediastinitis (if present) and excessive blood loss burden the unfavorable case of ABF, whereas stent-graft contamination and sepsis are the main concerns regarding endovascular therapy. We are presenting two patients with secondary ABF treated with thoracic endovascular repair who completed long-term follow-up without complications or evidence of infection.


Assuntos
Falso Aneurisma/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Doenças da Aorta/cirurgia , Implante de Prótese Vascular , Fístula Brônquica/cirurgia , Procedimentos Endovasculares , Fístula Vascular/cirurgia , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Angiografia Digital , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/etiologia , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/etiologia , Aortografia/métodos , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Fístula Brônquica/diagnóstico por imagem , Fístula Brônquica/etiologia , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/etiologia
20.
Future Cardiol ; 15(2): 85-88, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30848672

RESUMO

We present a 33-year-old man with atypical chest pain and with no significant past medical history. The patient was finally diagnosed as a case of huge fistula from the left main coronary artery to the right atrium, a very rare condition with challenging diagnostic and therapeutic approaches. The majority of cases of coronary artery fistula are small, asymptomatic and clinically undetectable; they frequently do not cause any complications and can spontaneously resolve. However, larger fistulas are frequently three times the size of a typical caliber of a coronary artery and may or may not cause symptoms or complications.


Assuntos
Dor no Peito/etiologia , Aneurisma Coronário/complicações , Vasos Coronários , Dispneia/etiologia , Átrios do Coração , Esforço Físico , Fístula Vascular/complicações , Adulto , Procedimentos Cirúrgicos Cardíacos/métodos , Dor no Peito/diagnóstico , Aneurisma Coronário/diagnóstico , Aneurisma Coronário/cirurgia , Angiografia Coronária , Dispneia/diagnóstico , Ecocardiografia Transesofagiana , Cardiopatias/complicações , Cardiopatias/diagnóstico , Cardiopatias/cirurgia , Humanos , Masculino , Índice de Gravidade de Doença , Fístula Vascular/diagnóstico , Fístula Vascular/cirurgia
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