Left and Right Coronary Artery to Left Ventricular Fistula: Demonstration of Myocardial Ischemia by Treadmill Test and Holter Monitoring—A Case Report

Abstract Background Single coronary artery (SCA) is a rare congenital coronary anomaly with incidence of 8–66 per 100 000 cases. Percutaneous coronary intervention (PCI) in patients with SCA is technically challenging. This is a case of bifurcation angioplasty involving left anterior descending/right coronary artery (LAD/RCA) in a patient with SCA and 1-year follow-up with computed tomography coronary angiography (CTCA). Case summary A 52-year-old female with history of PCI to LAD 4 months back, presented with non-ST-elevation myocardial infarction. Coronary angiogram showed 90% stenosis in mid-LAD, distal to the previous stent and proximal to an anomalously originating RCA from mid-LAD. She was planned for LAD/RCA provisional bifurcation angioplasty and a drug-eluting stent was deployed in LAD across RCA, following which patient developed angina with ischaemic electrocardiogram (ECG) changes due to significant pinching of RCA. Using Reverse crush technique, RCA was stented successfully with resolution of angina and ECG changes. At 1-year follow-up, patient is in New York Heart Association class I with normal left ventricular function and patent LAD/RCA bifurcation stent on CTCA. Discussion SCA poses a great challenge to interventional cardiologists during PCI, especially in the event of a complication. Detailed anatomical knowledge, appropriate hardware and operator expertise are the key factors for successful PCI of SCA. This is, to the best of our knowledge, the first case report of bifurcation angioplasty of LAD/RCA in a rare case of SCA. This case also describes the use of reverse crush technique as a bailout strategy during provisional bifurcation angioplasty.

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Successful interdisciplinary treatment as a rare cause of acute myocardial ischemia by intermittent tumor-associated obstruction of the left main coronary artery– A case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab292 ◽

2021 ◽

Author(s):

Katharina Huenges ◽

Franz Hartmann ◽

Bernd Panholzer ◽

Thomas Puehler

Keyword(s):

Case Report ◽

Coronary Artery ◽

Aortic Valve ◽

Myocardial Ischemia ◽

Left Main Coronary Artery ◽

Left Ventricular ◽

Papillary Fibroelastoma ◽

Interdisciplinary Treatment ◽

Bridge To Surgery ◽

Left Main

Abstract Background A papillary fibroelastoma of the aortic valve has been reported as a rare cause of myocardial ischemia. An advanced combined interventional and surgical approach leading to sufficient therapy for the patient is presented in this case report. Case summary A 56-year old female patient presented in an emergency room of a hospital with an acute coronary syndrome. Over 1.5 years, recurrent stable angina had been known in the patient and significant coronary artery disease has already been ruled out in a previous coronary angiogram. The patient was immediately transferred to the catheter laboratory due to cardiogenic shock where a drug-eluting stent was implanted to, firstly, recanalize the left main coronary artery and, secondly, to protect the left main ostium from obstruction by an echocardiographic-proven mass. During subsequent deterioration of hemodynamics caused by decreasing left ventricular function and acute severe mitral insufficiency, firstly an intra-aortic balloon pump and secondly a VA-ECMO was established through the femoral vessels. The patient was transferred to our cardiac surgery unit and was successfully operated utilizing a valve-sparing technique by extracting the tumor mass from the left coronary cusp and extracting the stent carefully from the left main coronary artery. Histology revealed a papillary fibroelastoma (Figure 4). Conclusion A papillary fibroelastoma of the aortic valve with intermittent obstruction of the coronary arteries requires surgical therapy. Interventional recanalization and extracorporeal support might be useful strategies to ensure the patient’s safety as a bridge to surgery.

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Asymptomatic left and right coronary artery-left ventricular fistula in an elderly patient with a diastolic murmur only

International Journal of Cardiology ◽

10.1016/0167-5273(89)90117-4 ◽

1989 ◽

Vol 25 (2) ◽

pp. 244-246 ◽

Cited By ~ 4

Author(s):

Shigeru Yokawa ◽

Hideto Watanabe ◽

Masao Kurosaki

Keyword(s):

Elderly Patient ◽

Coronary Artery ◽

Right Coronary Artery ◽

Left Ventricular ◽

Left And Right ◽

Diastolic Murmur

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Right Coronary Artery Dilatation with Left Ventricular Fistula: A Case Report

Advances in Clinical Medicine ◽

10.12677/acm.2021.117428 ◽

2021 ◽

Vol 11 (07) ◽

pp. 2961-2965

Author(s):

晔朱

Keyword(s):

Case Report ◽

Coronary Artery ◽

Right Coronary Artery ◽

Left Ventricular ◽

Coronary Artery Dilatation

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Multiple Left and Right Coronary Artery-left Ventricular Fistulas

Internal Medicine ◽

10.2169/internalmedicine.8843-17 ◽

2017 ◽

Vol 56 (18) ◽

pp. 2535-2536

Author(s):

Mitsutaka Nakashima ◽

Kei Yunoki ◽

Katsumasa Miyaji ◽

Hiromi Matsubara

Keyword(s):

Coronary Artery ◽

Right Coronary Artery ◽

Left Ventricular ◽

Left And Right

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Mobilization of an anomalous retro aortic coronary artery to prevent myocardial ischemia after aortic valve replacement

10.22541/au.161632218.80675788/v1 ◽

2021 ◽

Author(s):

José Máximo ◽

Paulo Pinho ◽

Jorge Casanova

Keyword(s):

At Risk ◽

Case Report ◽

Coronary Artery ◽

Aortic Valve ◽

Myocardial Ischemia ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Coronary Arteries ◽

Right Coronary Artery ◽

Valvular Surgery

During valvular surgery, abnormal coronary distribution, especially if unidentified by preoperative exams, may put coronary arteries at risk of damage. In this case report, we describe the approach to an anomalous right coronary artery during aortic valve replacement.

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A typical presentation of right coronary artery occlusion

Medicinski pregled ◽

10.2298/mpns0510498i ◽

2005 ◽

Vol 58 (9-10) ◽

pp. 498-502

Author(s):

Vladimir Ivanovic ◽

Nikola Jelkic ◽

Svetozar Srdic ◽

Miroslav Bikicki ◽

Tibor Canji ◽

...

Keyword(s):

Ventricular Tachycardia ◽

Chest Pain ◽

Coronary Artery ◽

Myocardial Ischemia ◽

Right Coronary Artery ◽

Collateral Circulation ◽

Left Ventricular ◽

Inferior Wall ◽

Atypical Chest Pain ◽

St Segment Elevation

Introduction Inferior wall myocardial infarctions are usually benign and uncomplicated and rarely result in ventricular disturbances of the heart rhythm. An unusual presentation of an inferior acute myocardial infarction (AMI) with atypical symptoms, and ventricular tachycardia is described. Case report A 44-year-old patient was admitted to the coronary care unit (CCU) due to atypical chest pain during exercise and ECG abnormalities in leads L2. L3 and aVF. On admission, ECG could mimic myocarditis, pericardia/ effusion, left anterior bundle branch block or early repolarization. Two-dimensional echo-cardiography revealed a hypertrophic myocardium without abnormal regional wall motion, good left ventricular function and ejection fraction of 65%. The presumptive prediction of a culprit artery based on the ECG recorded on admission was conclusive for inferior AMI. Fibrinolytic therapy was started 3 hours after the onset of chest pain. Resolution of ST segment elevation and relief of chest pain occurred within one hour of the infusion. On the fifth day after admission, the patient had a nonsustained ventricular tachycardia (VT) which was resolved with amioda-one. Angiography showed acute occlusion of the mid portion, right coronary artery (RCA) and collateral circulation in the distal portion. Discussion and conclusion Malignant ventricular arrhythmias can result from isolated inferior wall AMI, but literature reports on this phenomenon are rather rare. Collateral circulation can prevent myocardial ischemia and preserve myocardial function, but does not provide protection against exercise-induced myocardial ischemia.

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