Mysterious window: A right coronary artery-left ventricular fistula diagnosed by multiple imaging methods

Prevalence of primary coronary cameral fistula (CCF) is extremely rare, especially for CCF with the drainage site into the left ventricle. We describe a 45-year-old patient with chest tightness in whom a giant aneurysm associated with proximal right coronary artery (RCA), and the distal end of RCA terminated into the left ventricle through a fistula was discovered by echocardiography. Dual-source computer tomography revealed the CCF-related giant RCA aneurysm. The drainage site and coexistent abnormality could not be visualized well by coronary artery angiography because of the severely diluted contrast medium into the aneurysm. Finally, the patient received surgical treatment and is asymptomatic now.

A giant isolated right coronary aneurism

A previously healthy 32-year-old female hailing from Mexico presented to the emergency department with rectorrhagia. Caseating granulomas were detected on histopathological analysis from cecum ulcerative lesions. A purified protein derivative skin test resulted positive. In order to exclude pulmonary tubercolosis a CT lung scan was performed: a rounded and voluminous mass, located above the right atrioventricular cardiac junction, was unexpectedly revealed. Further a cardiac magnetic resonance and a coronary angiography disclosed a giant (5 × 4,8 cm) isolated aneurysm of proximal right coronary artery with severe thrombotic layering. The patient was treated with isoniazid, rifampin, ethambutol, and pyrazinamide; after approximately 2 months of treatment she had complete resolution of cecal lesions. Anticoagulant oral therapy with warfarin was started and the patient was submitted to CABG.

Rare case of Kawasaki disease with cardiac tamponade and giant coronary artery aneurysms

Kawasaki disease is an acute systemic vascular disease, generally self-limited and typically affecting children <5 years old, which leads to coronary artery aneurysms in about 25% of untreated cases. Cardiovascular involvement is characterised by transient pancarditis, in acute phase, while coronary illness, ranging from mild dilation to giant CAAs occurs late, rarely before the 10th day since fever onset. Here, we describe a peculiar case of KD, which occurred in a 4-month-old infant and presented with exudate cardiac tamponade and early giant aneurism of both the proximal right coronary artery) and the left circumflex coronary artery, in acute phase of the disease.

Case report: Synergetic effect of ischaemia and increased vagal tone inducing ventricular fibrillation in a patient with Brugada syndrome

Background Brugada syndrome (BS) is a hereditary channelopathy associated with syncope, malignant ventricular arrhythmia, and sudden cardiac death. Right ventricular ischaemia and BS have similar underlying substrates precipitating ventricular tachycardia or fibrillation (VF). Case summary A 72-year-old woman with BS and a stenosis on the proximal right coronary artery received several subsequent implantable cardioverter-defibrillator shocks due to VF during an episode of extreme nausea with vomiting. Discussion This case report emphasizes on the synergetic effect of mild ischaemia and increased vagal tone on the substrate responsible for BS to create pathophysiological changes precipitating VF.

Exercise-Induced Bundle Branch Block - an Infrequent Incidence

We describe an elderly woman who underwent a treadmill test preoperatively and was found to have Exercise-induced Left Bundle Branch Block without chest pain. Coronary angiogram was done which revealed a 70% stenosis in the fi rst diagonal branch of Left Anterior Descending Artery and a 40% lesion in proximal Right Coronary Artery. Available literature attributes rate-dependent transient conduction defects to obstructive lesions of coronary arteries, slow arterial blood fl ow, vasospasms as well as pathology in the Bundle of His.