scholarly journals Severe Dilated Cardiomyopathy Resulted from a Large Single Coronary Artery Fistula Drained Into the Left Ventricle

2020 ◽  
Vol 23 (5) ◽  
pp. E586-E589
Author(s):  
Seung Hun Lee ◽  
Jae Young Cho ◽  
Ho Sung Sho ◽  
Cheol Woong Yu
Keyword(s):  
Coronary Artery ◽  
Left Ventricle ◽  
Dilated Cardiomyopathy ◽  
Rare Condition ◽  
Lateral Wall ◽  
Coronary Artery Fistula ◽  
Posterior Wall ◽  
Single Coronary Artery ◽  
Surgical Ligation ◽  
Hemodynamic Deterioration

Background: Coronary artery fistula (CAF) draining into the left ventricle (LV) is a rare condition and dilated cardiomyopathy (DCMP) that results from single coronary artery (SCA) accompanied by CAF also is extremely rare. Case report: We report the case of a 36-year-old man, who presented with severe DCMP that resulted from SCA with CAF draining into the LV. Transthoracic echocardiogram (TTE) showed severe diffuse hypokinesia of the LV with ejection fraction (EF) of 15-20%. Coronary angiography (CAG) revealed SCA connected between left anterior descending artery (LAD) and posterior descending artery (PDA), course of the PDA was very tortuous from apex to base of the LV, and connected to posterior lateral (PL) branch, which was drained into the LV at distal part of the PL. Coronary artery computed tomography (CACT) showed LAD ran over the apex of the LV and connected to PDA, which was drained into the mid portion of lateral wall of the LV. Cardiac magnetic resonance imaging (CMRI) showed no evidence of irreversible myocardial change in global wall of the LV. The patient underwent surgical ligation of PDA near the base of the posterior wall of the LV as close to the entry of CAF to the LV as possible without any surgery-related complications. Three months after the surgical ligation, follow-up TEE  showed much improved EF of 45-50%. He has been doing well without congestive heart failure (CHF) until now. Discussion: Symptomatic CAF with hemodynamic deterioration may need mechanical correction of CAF, including surgical ligation or percutaneous interventional occlusion. How to treat this condition in terms of methodology is a very difficult issue. The detailed methods related to surgical or interventional correction of CAF have to be determined based on anatomical characteristics of CAF, underlying comorbidities, and relevant complications risk.

Propranolol as a treatment for multiple coronary artery micro-fistulas

2014 ◽  
Vol 25 (2) ◽  
pp. 380-383 ◽  
Author(s):  
María Hernández ◽  
Juan M. Carretero ◽  
Fredy Prada
Keyword(s):  
Coronary Artery ◽  
Left Ventricle ◽  
Chromosomal Abnormality ◽  
Transcatheter Closure ◽  
Coronary Artery Fistula ◽  
Surgical Ligation ◽  
Malformative Syndrome

AbstractWe present a case of congenital multiple coronary artery–left ventricle micro-fistulas, which were treated with propranolol disappearing within 6 months. She had a malformative syndrome associated with a chromosomal abnormality. The treatment for coronary artery fistula includes surgical ligation and transcatheter closure, but they are not indicated in congenital micro-fistulas. We propose propranolol as a treatment in this type of diffuse fistula.

scholarly journals P1337 Left ventricle outpouchings. Assesing diagnostic complexity

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
S Blasco Turrion ◽  
L Marcos Fuentes ◽  
A Moruno Tirado ◽  
F Coserria Sanchez ◽  
I Valverde Perez
Keyword(s):  
Left Ventricle ◽  
Dilated Cardiomyopathy ◽  
Recent Article ◽  
Rare Condition ◽  
Diagnostic Algorithm ◽  
Lateral Wall ◽  
Diagnostic Process ◽  
Papillary Muscles ◽  
Apical Side ◽  
The Right

Abstract Congenital left ventricle outpouchings (LVO) are a very rare condition that include left ventricle accessory chamber, left ventricle aneurysm (LVA), left ventricle diverticulum (LVD), double-chambered left ventricle and accessory left ventricle, without well-stablished diagnostic criteria. A recent article by Elaheh Malakan et al tries to show this difficulties and propose an algorithm to help define this different pathologies. We present the case of a 26-day-old boy that was admitted to our Hospital with suspicion of dilated cardiomyopathy. In his physical exam a systolic murmur was detected, and his mother described tiredness during intakes and tachypnea. His ECG showed a sinus rhythm, with an 80º QRS axis. No signs of hypertrophy or dilated cavities were detected. As part of the study a TTE was performed, detecting a dilated left ventricle with a tract crossing the apical side from the LV lateral wall. The MRI confirmed the presence of an incomplete muscular septum from de LV lateral wall up to the apex encompassing the papillary muscles in the mid left ventricle, dividing the LV in two chambers with telediastolic size of 3.5x3cm and 2.6x2.4cm respectively. This secondary appendix, with a pseudoaneurysm morphology, distended in systole with a dyskinetic motion. Globally, the left ventricle was dilated and had mild systolic disfunction. The right cavities were morphological and functionally normal. In this case initially a common dilated cardiomyopathy was suspected, being able to confirm the presence of a muscular tract crossing the mid left ventricle. The MRI described the image as an LV pseudoaneurysm, however the TTE images and the diagnostic algorithm proposed by Elaheh Malakan et al would include this case as a two-chamber left ventricle, denoting the still present difficulties in the diagnostic process in these cases, and its impact in their therapeutic approach. Abstract P1337 Figure.

Coronary artery fistula to the left ventricle

1987 ◽  
Vol 23 (3) ◽  
pp. 420
Author(s):  
B H Lee ◽  
S J Yu ◽  
E S Moon ◽  
S H Kim ◽  
Y H Choi
Keyword(s):  
Coronary Artery ◽  
Left Ventricle ◽  
Coronary Artery Fistula

Congenital Left Main Coronary Artery to Coronary Sinus Fistula

2011 ◽  
Vol 14 (4) ◽  
pp. 255 ◽  
Author(s):  
Fotios A. Mitropoulos ◽  
Meletios A. Kanakis ◽  
Periklis A. Davlouros ◽  
George Triantis
Keyword(s):  
Coronary Artery ◽  
Coronary Arteries ◽  
Coronary Sinus ◽  
Left Main Coronary Artery ◽  
Coronary Artery Fistula ◽  
Left Main ◽  
Coronary Fistula ◽  
Excellent Outcome ◽  
Surgical Ligation ◽  
Congenital Coronary Artery Fistula

Congenital coronary artery fistula is an extremely rare anomaly that may involve any of the coronary arteries and any of the cardiac chambers. We report the case of a 14-year-old female patient with a symptomatic congenital coronary fistula starting from the left main coronary artery and draining to the coronary sinus. The patient underwent surgical ligation of the fistula and had an excellent outcome.

scholarly journals P1736 An unexpected cause of ventricular tachycardia in a young patient

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
R Tomoaia ◽  
R S Beyer ◽  
M Puiu ◽  
A Dadarlat ◽  
F I Fringu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Ventricular Tachycardia ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Young Patient ◽  
Young Male ◽  
Rare Condition ◽  
Lateral Wall ◽  
Final Diagnosis ◽  
Reduced Ejection Fraction

Abstract Introduction Hypoplastic coronary artery disease (HCAD) refers to a congenital underdevelopment of one or more coronary arteries, which are greatly reduced in diameter or length. It is a rare congenital abnormality which has rarely been documented in living patients and which may lead to myocardial infarction (MI) and sudden cardiac death (SCD). This case describes an otherwise healthy young male, which was admitted in the emergency department (ED) for repeated sustained ventricular tachycardia (VT) and was thereby diagnosed with an isolated hypoplasia of the left circumflex coronary artery (CX). Investigations revealed scar-related tachycardia, due to a prior silent myocardial infarction caused by HCAD. These findings were suggested by echocardiography and coronary angiography and were later confirmed by magnetic resonance and 3D cardiac mapping. Case Report A 34-year-old male patient was admitted to the intensive care unit with recurrent sustained VT causing hemodynamic instability. After receiving two electric shocks and amiodarone in the ambulance, the patient became hemodynamically stable. There was no remarcable medical history besides a syncopal fall 5 years before and no symptoms prior to the current event. Initial physical examination, ECG and laboratory testing were normal. Echocardiography revealed a dilated left ventricle with akynesia of the lateral wall and a mildly reduced ejection fraction (EF = 45%), moderate mitral regurgitation due to restriction of the posterior mitral leaflet. A subsequent emergent coronary angiography was therefore performed, which showed no sign of atherosclerotic lesions, yet it revealed a hypoplastic CX, without compensatory collateral vessels supplying the lateral wall. Cardiac MR demonstrated delayed enhancement with transmural necrosis and no viability in the lateral wall of the LV, suggesting a long-standing MI. Therefore, the final diagnosis was scar-related VT, due to a prior silent MI caused by HCAD. The management of this patient included implantation of an ICD in the secondary prevention of SCD. Moreover, we performed an EPS, which identified a scar at the level of the lateral and inferolateral LV walls as a substrate for VT (electroanatomic 3D voltage mapping) and of the critical istmus (3D activation mapping). The next step was radiofrequency ablation of the critical isthmus, with no inducibility of the VT after the procedure. After 6-months follow-up, there was no recurrence of the VT. Conclusion Finding the cause of myocardial infarction in a young patient with VT can be very challenging. We emphasise the role of imaging for the diagnosis and management of these patients. HCAD is a rare congenital anomaly, which can lead to progressive fibrosis in the territory with poor blood supply, MI and SCD. Although it is a rare condition, it should be considered in young adults who present with MI and/or SCD. Abstract P1736 Figure. Investigations

An aneurysmal right coronary artery fistula draining into the left ventricle

2017 ◽  
Vol 27 (6) ◽  
pp. 1214-1215
Author(s):  
Dongxu Li ◽  
Yabo Wang ◽  
Qi An
Keyword(s):  
Coronary Artery ◽  
Left Ventricle ◽  
Right Coronary Artery ◽  
Rare Case ◽  
Median Sternotomy ◽  
Coronary Artery Fistula ◽  
Ct Images ◽  
Coronary Ct

AbstractWe describe a rare case of aneurysmal right coronary artery drainage into left ventricle in a 38-year old male with entailed coronary CT images. After median sternotomy surgery, the patient recovered well.

scholarly journals Multiple Small Coronary Artery Fistulas Emptying into the Left Ventricle: A Rare but Challenging Problem

2016 ◽  
Vol 2016 ◽  
pp. 1-3
Author(s):  
Omar Kahaly ◽  
Konstantinos Dean Boudoulas
Keyword(s):  
Coronary Artery ◽  
Left Ventricle ◽  
Coronary Artery Fistula ◽  
Coronary Arteriography ◽  
Great Vessel ◽  
Challenging Problem ◽  
Atypical Chest Pain ◽  
Coronary Artery Fistulas ◽  
Appropriate Therapy ◽  
The Right

A coronary artery fistula (CAF) is an abnormal communication between a coronary artery and a cardiac chamber or a great vessel. CAFs are rare based on coronary arteriography and when found they most often empty into the right ventricle and atrium and less often into the high pressure, low compliance left ventricle (LV). A patient who presented with atypical chest pain and was found to have multiple small CAFs originating from the ramus intermedius coronary artery and emptying into the LV is presented. This case highlights the challenges in providing an appropriate therapy for multiple small CAFs emptying into the LV.

scholarly journals Normal Coronary Artery Patient Presenting with Left Ventricular Aneurysm

2011 ◽  
Vol 2011 ◽  
pp. 1-3 ◽  
Author(s):  
Hakan Altay ◽  
Cihan Altin ◽  
Ali Çoner ◽  
Haldun Muderrisoglu
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Dilated Cardiomyopathy ◽  
Posterior Wall ◽  
Anterior Wall ◽  
Left Ventricular ◽  
Idiopathic Dilated Cardiomyopathy ◽  
Left Ventricular Aneurysm ◽  
Ventricular Aneurysm ◽  
Distinct Area

Left ventricular aneurysm (LVA) is one of the most important complications of myocardial infarction LVA is strictly defined as a distinct area of abnormal left ventricular diastolic contour with systolic dyskinesia or paradoxical bulging. LVA usually results from myocardial infarction. Other rare aetiologies of LVA include hypertrophic cardiomyopathy, Chagas' disease, sarcoidosis, congenital LVA, and idiopathic However, LVA formation in patients with idiopathic dilated cardiomyopathy is rarely reported, and the incidence, clinical features, and pathogenesis of LVA formation in patients with idiopathic dilated cardiomyopathy is not well understood. Here, we present a 45 years old, idiopathic dilated cardiomyopathy patient with LVA and normal coronary arteries The pathogenesis of LVA formation in patients with idiopathic dilated cardiomyopathy is not clear. One acceptable hypothesis is that coronary artery emboli originate from mural thrombi, present in some patients with idiopathic dilated cardiomyopathy, which develop due to local wall infarction and fibrosis. The local myocardial perfusion differences could be seen in idiopathic dilated cardiomyopathy and predominantly found in the anteroposterior axis of the left ventricle. Local fibrosis occurs more frequently on the anterior wall or posterior wall, and less frequently on the lateral or septal wall. In our patient, LVA existed in the septal segments.We could not define the exact mechanism of the septal aneurysm in our patient but we decided to present this abnormal case, which is different from cases thus far reported in the literature.

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