CASE REPORT OF AN ACUTE CORONARY SYNDROME IN A PATIENT WITH ARTERY CORONARY FISTULAE

Background Coronary artery fistulae are rare vascular anomalies. Although they are usually asymptomatic, the presence of symptoms might suppose a challenge in the diagnostic and therapeutic management. Case summary we present a patient with chest pain, all the initial tests were normal, but coronary artery fistulae were found. SPECT test showed ischemia due to coronary artery fistulae and cardiac CT helped in the planning of the percutaneous closure. Discussion Cardiac computed tomography (CCT) is an emerging optimal non-invasive tool to characterize their morphology and course, resulting essential for accurate diagnosis and eventually, planning the percutaneous closure.

Safe Decompression of the Right Ventricle for PAIVS in Neonates With Coronary Fistulae: Including the Selective Use of Fistula Ligation to Avoid Coronary Steal

Background: There are a number of surgical and interventional treatment options for infants with pulmonary atresia with intact ventricular septum (PAIVS). In our practice, we characterize coronary fistulae and interruptions with angiography in the newborn and have developed a strategy to safely decompress the right ventricle in association with ligation of fistulae if necessary. Methods: All infants operated for PAIVS at age < 60 days from 1999 to 2018 were retrospectively studied. Pre- and postoperative variables were collected, angiograms were reviewed, and a territory score was created to grade the severity of coronary abnormalities. This study focused on the subgroup of patients who had early surgical decompression of the right ventricle. Results: A total of 77 patients were included, with a mean follow-up of 8.6 years. Of these, 55 (71%) had coronary fistulae, including 28 (36%) with coronary artery interruption. Right ventricular decompression (RVD) was performed in 47 (60.5%) patients. There was no 30-day mortality in those who underwent RVD, whereas 6 (20%) without RVD died within 30 days ( P = .003). Ten-year survival was 97.8% and 73.3% for RVD and non-RVD, respectively. In order to prevent coronary steal, 17 patients underwent coronary fistula ligation as their RV was decompressed with 100% early and late survival. Conclusion: Early and late survival in infants with PAIVS is better if the RV can be decompressed. Coronary fistula ligation with RVD has been introduced without an adverse outcome in selected patients with large fistulae.