Multiple coronary artery-left ventricular fistulae: clinical, angiographic, and pathologic findings

Multiple fistulae between all 3 major coronary arteries and the left ventricle were found at cardiac catheterization in a 69-year-old woman presenting with typical angina. Subsequent necropsy showed abnormal intramyocardial vessels communicating with the left ventricular lumen. This is the first report to document clinical, angiographic, and pathologic findings in this anomaly.     

Detection of myocardial ischaemia caused by coronary artery-left ventricular fistulae using myocardial contrast echocardiography

A coronary artery-left ventricular fistula (CAF) is an extremelyrare anatomical abnormality in which blood drains directly froma coronary artery into the left ventricle. CAF may cause myocardialischaemia and angina. Myocardial contrast echocardiography (MCE)is a non-invasive technique which assesses myocardial perfusion.We describe a patient with CAF in whom transmural myocardialischaemia was demonstrated using MCE.     

Coronary artery-left ventricular fistulae associated with apical hypertrophic cardiomyopathy.

We describe an unusual case of coronary artery-left ventricular fistulae associated with apical hypertrophic cardiomyopathy in a 63-year-old man who had a 2-year history of angina pectoris without significant coronary atherosclerosis. It is important to recognize this anomaly as it may be the source of angina in patients without angiographic evidence of major atherosclerotic coronary artery disease.     

Coronary artery-left ventricular fistulae with atrial septal defect

We describe a 65-year-old woman who had coronary artery-left ventricular fistula associated with atrial septal defect of the sinus venosus type, and left-sided heart failure. Although a cardiac valve anomaly associated with coronary artery fistula has been described, atrial septal defect has not been reported previously in this condition.     

Diagnosis of a right coronary artery-left ventricular fistula by cross sectional and Doppler echocardiography.

A case of right coronary to left ventricular fistula was diagnosed by cross sectional and Doppler echocardiography. The origin and site of entry into the left ventricle of the enlarged right coronary artery were shown by cross sectional echocardiography. Diastolic flow was detected in the left ventricle by both pulsed and continuous Doppler echocardiography. The fistula was confirmed by cardiac catheterisation and was successfully closed at operation.     

Multiple coronary artery-left ventricular fistulas associated with hereditary hemorrhagic telangiectasia

Coronary artery-left ventricular (LV) fistulas are extremely rare and can cause myocardial ischemia from coronary steal. We describe an elderly woman who presented with unstable angina from multiple and extensive coronary artery-LV fistulas. She also had clinical features suggestive of hereditary hemorrhagic telangiectasia (HHT). Association of coronary artery-LV fistulas with HHT has not been reported and can pose a management dilemma in view of the risks of extensive cardiopulmonary surgery and potential complications of myocardial ischemia, stroke, and brain abscess.     

Diagnosis of a right coronary artery-left ventricular fistula by cross sectional and Doppler echocardiography

A case of right coronary to left ventricular fistula was diagnosed by cross sectional and Doppler echocardiography. The origin and site of entry into the left ventricle of the enlarged right coronary artery were shown by cross sectional echocardiography. Diastolic flow was detected in the left ventricle by both pulsed and continuous Doppler echocardiography. The fistula was confirmed by cardiac catheterisation and was successfully closed at operation.     

Multiple coronary arteriovenous fistulae.

A case with multiple congenital coronary arteriovenous fistulae is reported. The right coronary artery was communicating with the right ventricle. The left coronary artery was entering directly into the pulmonary trunk and two terminal branches of the anterior descending into the left ventricle. The direct communication of the left coronary artery without interposition of an accessory artery or a circoid plexus is met for the first time.     

应用血管内多普勒超声评价主动脉瓣返流对冠状动脉血流的影响

目的应用血管内多普勒超声评价主动脉瓣返流对冠状动脉血流的影响。方法选取慢性重度的主动脉瓣返流患者12例,先行冠状动脉造影检查,排除冠心病,再行冠状动脉内多普勒检查,测定前降支中远端的平均峰值流速(APV),舒张收缩流速比值(DSVR),冠状动脉血流储备(CFR)等,并测定左心室舒张末压力(LVEDP),用12例正常数据作对照。结果与正常对照相比,主动脉瓣返流患者 APV 升高[(45.8±19.5)cm/s vs.(23.5±15.4)cm/s,P<0.05];DSVR 降低[(1.4±0.8)vs.(2.6±1.7),P<0.05];CFR 降低[(1.5±1.9)cm/s vs.(3.8±2.1)cm/s,P<0.05];LVEDP 升高[(20.6±10.5)mm Hg(1 mm Hg=0.133 kPa)vs.(8.2±5.6)mm Hg,P<0.05];前降支中段内径无变化[(3.8±1.5)mm us.(3.5±1_4)mm,P>0.05]。结论慢性重度主动脉瓣返流对冠状动脉血流有显著影响,表现为基础状态时 APV 升高,而 DSVR 和 CFR 降低,并使左心室舒张功能减低。CFR减低可能是冠状动脉造影正常的主动脉瓣返流患者心绞痛的主要机制。     

多普勒导丝评价猪急性冠状动脉闭塞侧支循环状态及硝酸甘油的影响

目的应用冠状动脉内多普勒导丝评价猪冠状动脉急性闭塞后侧支循环状况及硝酸甘油对其的影响.方法使用冠状动脉内多普勒导丝测定14头小型家猪正常状态及左回旋支急性闭塞后远端血管的血流频谱,并观察冠状动脉内应用硝酸甘油对其的影响.结果急性闭塞左回旋支远端的平均峰值流速(APV)明显低于正常[(0.97±1.05)cm/svs.(25.78±4.36)cm/s,P<0.01];应用硝酸甘油后梗死相关血管(IRA)血流呈现逆向或双向,APV绝对值较用药前明显增加[(0.97±1.05)cm/svs.(8.32±1.53)cm/s,P<0.01];闭塞后90 min基础及重复用药后APV分别为(0.99±1.14)cm/s和(9.02±1.47)cm/s,较闭塞即刻差异均无统计学意义.结论多普勒导丝可用来评价冠状动脉侧支循环,猪急性冠状动脉闭塞时侧支循环自身建立不足,硝酸甘油可明显增加冠状动脉侧支循环血流.     

Multiple coronary arterioventricular fistulae

A 62-year-old man who died suddenly was found at autopsy to have multiple coronary arteriosystemic fistulae involving all three major coronary arteries and both ventricles. This is the second such case reported and the first with biventricular involvement and autopsy findings. A congenital bicuspid valve was also present. Numerous small blood vessels opened onto the endocardial surface of both ventricles and there were microscopic foci of persistent embryonic spongy myocardium.     

Aortocoronary dissection resolved by coronary stenting guided by intracoronary ultrasound.

Percutaneous coronary intervention (PCI) was performed for chronic total occlusion of the proximal right coronary artery in a 70-year-old male with unstable angina. The forceful manipulation of the guide catheter led to an aortocoronary dissection involving the right Valsalva sinus and the ascending aorta. Intracoronary ultrasound (ICUS) showed the important characteristics of the dissection, enabling successful coronary stenting under ICUS guidance.     

冠状动脉内超声显像与造影对冠状动脉病变检出的比较

目的研究冠状动脉造影（ＣＡＧ）正常者的冠状动脉内超声显像（ＩＣＵＳ）检查结果，结合临床表现及辅助检查，藉以提出ＩＣＵＳ检查的适应证。方法对连续４００例临床待诊或确诊为冠心病的患者行ＣＡＧ同时行ＩＣＵＳ检查。结果４００例患者中，１３５例ＣＡＧ正常者，而ＩＣＵＳ检查示：２８例正常，３８例冠状动脉内膜增厚，６９例有不同性质的斑块。分组分析，斑块组与非斑块组之间的冠心病高危因素比较，差异有显著性（Ｐ＜００５）。结论表明ＩＣＵＳ对冠状动脉病变的检出较ＣＡＧ敏感，认为ＣＡＧ检查结果正常者，若临床上心绞痛症状典型、年龄较大、血脂较高、吸烟及心电图有异常改变者，尤其是男性患者宜进一步行ＩＣＵＳ检查。