Coronary Recanalization Due to Presumed Thrombosis Following Surgical Ligation of a Large Right Coronary Artery to Right Ventricle Fistula

We report angiographic findings in an infant with congestive heart failure due to a large right coronary artery to right ventricular fistula who underwent surgical ligation. Repeat catheterization 2 years later unexpectedly showed extensive thrombosis of the right coronary artery with multiple recanalized channels supplying the right coronary distribution. Review of the literature showed that this may not be an uncommon finding.     

先天性冠状动脉瘘的治疗

冠状动脉瘘是一种连接于一支或多支冠状动脉与某一心腔或心脏周围血管之间的先天性或获得性冠状动脉畸形。发生率在先天性心脏疾病中为0.13%,而在总人群中的发病率大约为0.002%。最主要的症状为"窃血现象"导致的心肌缺血性症状。经典治疗方法为手术治疗,但随着介入治疗的发展,目前冠状动脉瘘临床治疗方案的选择尚存在争议,有待进一步的临床研究。     

Traumatic Coronary Artery Fistula Closure with Stent Graft

We present a rare case of a symptomatic acquired large coronary fistula and aneurysm secondary to chest trauma that was successfully closed using stent graft. This case is followed by review of the literature.     

Excision of Coronary Artery Fistula and Coronary Artery Reconstruction Without Cardiopulmonary Bypass

Abstract In three patients, coronary artery fistulas originating from a conal branch of the midsegment of the left anterior descending coronary artery (n = 2) and right coronary artery (n = 1) with drainage into the right atrium (n = 2) and right ventricle (n = 1) were successfully closed without the use of cardiopulmonary bypass. The use of a coronary artery stabilizer greatly facilitated the operation by immobilization of the fistula, its supplying coronary artery, and the regional myocardium. In selected patients, this technique allows secure closure of the fistula and meticulous reconstruction of the coronary artery without the use of cardiopulmonary bypass.     

先天性冠状动脉瘘5例治疗体会

总结先天性冠状动脉瘘５例手术治疗体会。作者认为：冠状动脉瘘虽为罕见先天性心脏畸形,但手术安全,效果良好。非手术治疗远期可发生心肌缺血、心肌梗死、冠状动脉瘤破裂等并发症。故一经确诊,均宜手术治疗。手术方法以体外循环下切开瘘口所在心腔或冠状动脉缝闭瘘口为宜。冠状动脉造影可确定瘘口位置,具有确诊价值。     

先天性心脏病冠状动脉瘘的介入治疗

收集近年来国内外先天性冠状动脉瘘100例介入文献与85例手术文献,分析冠状动脉瘘的类型,治疗方法及预后。冠状动脉瘘起源于左冠状动脉多见,出口多在右心。单一冠状动脉瘘可以考虑以经导管介入封堵治疗,这是创伤小,相对安全有效的治疗手段且预后良好,适宜推广。合并其他先天性畸形者或冠状动脉病变者以及介入治疗失败者考虑手术治疗。     

先天性心脏病冠状动脉瘘的诊断及治疗

近年来冠状动脉瘘的诊断和治疗取得了长足的发展,冠状动脉造影检查是诊断冠状动脉瘘的金标准,冠状动脉瘘经导管封堵术和外科手术闭合治疗均安全、有效。     

Infective Endocarditis Related to a Coronary Artery Fistula with an Unusual Localization and Ectatic Coronary Arteries

Coronary artery fistulas (CAF) are a rare cardiac anomaly that can be either congenital or acquired. CAFs have clinical significance because of complications such as dyspnea on exertion, congestive heart failure, and cardiac tamponade. The literature also contains case reports of CAF presenting as bacterial endocarditis. We describe a 31‐year‐old man who presented with native valve infective endocarditis related to an unusual form of a CAF between the circumflex coronary artery and left ventricle. He also had giant coronary arteries, which were imaged with computed tomography angiography and transesophageal echocardiography. The diameter of the circumflex coronary artery and left main coronary artery was measured as 19 mm. Surgical intervention for heart valves was performed because of vegetations resistant to continued antibiotic treatment. At the same time, the CAF was treated with surgery.     

Iatrogenic ST Elevation during Percutaneous Closure of a Coronary Artery Fistula

Coronary artery fistulae are an uncommon anomaly and, while frequently asymptomatic, may require interventional therapy. Transcatheter approaches for closure of coronary artery fistulae are now commonly used, with various methods of fistula occlusion described, including detachable coils. During a percutaneous procedure to occlude a symptomatic left anterior descending coronary artery to pulmonary artery fistula, the patient experienced chest discomfort with anterior ST segment elevation. We demonstrate an unusual, unique and striking ECG abnormality complicating the delivery of coils designed to occlude the fistula in the absence of coronary artery injury. The mechanisms of the procedural ECG changes are discussed, as are potential alternate diagnoses and associated therapy.     

Transcatheter Closure of a Peripheral Arteriovenous Fistula: A Unique Use of a Covered Stent in a Child with Complex Congenital Heart Disease

Introduction. This report describes the use of a covered stent to occlude a surgical arteriovenous fistula in a child with complex cyanotic heart disease. Method. A single case report. Results. An Atrium iCAST covered stent was delivered percutaneously to the left axillary artery in an 8‐year‐old child with a failing single‐lung Fontan who had undergone the creation of a surgical axillary arteriovenous fistula to augment pulmonary blood flow. The covered stent completely occluded the fistula, without complications or compromise of arterial flow to the upper extremity. The patient subsequently experienced significant improvement in peripheral edema, ascites and pleural effusions. Conclusion. Although a single case report, this experience suggests a potentially important role for covered stents in the management of children with complex congenital heart disease.     

Transesophageal Echocardiographic Diagnosis of a Congenital Circumflex Coronary Artery to Coronary Sinus Fistula in an Adult

We report a congenital circumflex coronary artery to coronary sinus arteriovenous fistula diagnosed by transesophageal echocardiography in a 38-year-old asymptomatic male. The coronary arteriovenous fistula was suggested by two-dimensional transthoracic color Doppler. A first nondiagnostic angiography was performed, and it was during the second one, that the fistula could finally be visualized after a special dye technique was used. The high fistula flow rate prevented us from seeing it with regular dye concentration. Transesophageal echocardiography was precise in the anatomical and hemodynamic evaluation and it was essential in guiding the angiographic examination and surgical repair.