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Left ventricular microfistulization: A rare cause of ischemia in a patient with normal coronary arteries

Year 2012, Volume: 39 Issue: 2, 299 - 301, 01.06.2012
https://doi.org/10.5798/diclemedj.0921.2012.02.0146

Abstract

A 71-year-old woman with chest pain occurring on physical exercise was admitted to cardiology department. Myocardial perfusion scintigraphy revealed inferior and anteroapical segment hypoperfusion. Selective coronary angiography revealed multiple coronary-cameral fistulas originating from the left anterior descending artery and the right coronary artery and emptying into the left ventricle without any significant coronary artery stenosis. Coronary artery fistulas are defined as abnormal communications between a coronary artery and a cardiac chamber or major vessel. Coronary-cameral fistulas terminating in the left ventricle are uncommon. Small fistulas usually do not cause any hemodynamic compromise. However, the larger and multiple fistulas may cause myocardial ischemia ascribed to a coronary steal phenomenon. The best way to manage cameral fistulae is uncertain largely due to the rarity of the condition. In the present case, anti-ischemic medications with metoprolol 50 mg/day provided an uneventful follow-up of six months without any intervention.

References

  • Luo L, Kebede S, Wu S, Stouffer GA. Coronary artery fistu- lae. Am J Med Sci 2006;332(2):79-84.
  • Iadanza A, del Pasqua A, Fineschi M, Pierli C. Three-vessel left-ventricular microfistulization syndrome: a rare case of angina. Int J Cardiol 2004;96(1):109-11.
  • Lessick J, Kumar G, Beyar R, Lorber A, Engel A. Anomalous origin of a posterior descending artery from the right pul- monary artery: report of a rare case diagnosed by multide- tector computed tomography angiography. J Comput Assist Tomogr 2004;28(6):857-9.
  • Brooks CH, Bates PD. Coronary artery-left ventricular fistula with angina pectoris. Am Heart J 1983;106(2):404–6.
  • Yilmaz H, Basarici I, Demir I. A rare cause of ischemia: congenital coronary-cameral fistula: case report. Turkiye Klinikleri J Cardiovasc Sci 2006;18(2):158-61.
  • Said SA, van der Werf T. Dutch survey of congenital coro- nary artery fistulas in adults: coronary artery-left ventricu- lar multiple micro-fistulas multi-center observational sur- vey in the Netherlands. Int J Cardiol 2006;110(1):33-9.
  • Sheikhzadeh A, Stierle U, Langbehn AF, Thoran P, Diederich KW. Generalized coronary arterio-systemic (left ventricu- lar) fistula. Case report and review of literature. Jpn Heart J 1986;27(4):533-44.

Left ventricular microfistulization: A rare cause of ischemia in a patient with normal coronary arteries

Year 2012, Volume: 39 Issue: 2, 299 - 301, 01.06.2012
https://doi.org/10.5798/diclemedj.0921.2012.02.0146

Abstract

Fizik egzersiz esnasında göğüs ağrısı oluşan 71 yaşında bayan hasta kardiyoloji bölümüne başvurdu. Miyokard perfüzyon sintigrafisinde inferior ve anteroapikal segmentlerde hipoperüzyon saptandı. Selektif koroner anjiyografide sol ön inen arter ve sağ koroner arterden köken alan ve önemli koroner arter darlığı yapmadan sol ventriküle boşalan çoklu korono-kameral fistüller saptandı. Koroner arter fistülleri bir koroner arter ile bir kalp odacığı veya büyük damar arasındaki anormal bağlantılar olarak tanımlanır. Sol ventrikülde sonlanan korono-kameral fistüller nadirdir. Küçük fistüller genellikle hemodinamik açıdan tehlike yaratmaz. Fakat daha büyük ve çoklu fistüller koroner çalma fenomenine atfedilen miyokard iskemisine neden olabilirler. Kameral fistüller çok nadir görüldüğü için nasıl en iyi şekilde tedavi edilecekleri belirsizdir. Bu olguda 50 mg/gün metoprolol ile anti-iskemik tedavi yapıldı ve hiçbir girişim yapılmaksızın hasta altı ay olaysız takip edildi.

References

  • Luo L, Kebede S, Wu S, Stouffer GA. Coronary artery fistu- lae. Am J Med Sci 2006;332(2):79-84.
  • Iadanza A, del Pasqua A, Fineschi M, Pierli C. Three-vessel left-ventricular microfistulization syndrome: a rare case of angina. Int J Cardiol 2004;96(1):109-11.
  • Lessick J, Kumar G, Beyar R, Lorber A, Engel A. Anomalous origin of a posterior descending artery from the right pul- monary artery: report of a rare case diagnosed by multide- tector computed tomography angiography. J Comput Assist Tomogr 2004;28(6):857-9.
  • Brooks CH, Bates PD. Coronary artery-left ventricular fistula with angina pectoris. Am Heart J 1983;106(2):404–6.
  • Yilmaz H, Basarici I, Demir I. A rare cause of ischemia: congenital coronary-cameral fistula: case report. Turkiye Klinikleri J Cardiovasc Sci 2006;18(2):158-61.
  • Said SA, van der Werf T. Dutch survey of congenital coro- nary artery fistulas in adults: coronary artery-left ventricu- lar multiple micro-fistulas multi-center observational sur- vey in the Netherlands. Int J Cardiol 2006;110(1):33-9.
  • Sheikhzadeh A, Stierle U, Langbehn AF, Thoran P, Diederich KW. Generalized coronary arterio-systemic (left ventricu- lar) fistula. Case report and review of literature. Jpn Heart J 1986;27(4):533-44.
There are 7 citations in total.

Details

Primary Language Turkish
Journal Section Case Reports
Authors

Cihan Şengül This is me

Ayşegül Sünbül This is me

Ender Semiz This is me

İsmet Dindar This is me

Publication Date June 1, 2012
Submission Date March 2, 2015
Published in Issue Year 2012 Volume: 39 Issue: 2

Cite

APA Şengül, C., Sünbül, A., Semiz, E., Dindar, İ. (2012). Left ventricular microfistulization: A rare cause of ischemia in a patient with normal coronary arteries. Dicle Tıp Dergisi, 39(2), 299-301. https://doi.org/10.5798/diclemedj.0921.2012.02.0146
AMA Şengül C, Sünbül A, Semiz E, Dindar İ. Left ventricular microfistulization: A rare cause of ischemia in a patient with normal coronary arteries. diclemedj. June 2012;39(2):299-301. doi:10.5798/diclemedj.0921.2012.02.0146
Chicago Şengül, Cihan, Ayşegül Sünbül, Ender Semiz, and İsmet Dindar. “Left Ventricular Microfistulization: A Rare Cause of Ischemia in a Patient With Normal Coronary Arteries”. Dicle Tıp Dergisi 39, no. 2 (June 2012): 299-301. https://doi.org/10.5798/diclemedj.0921.2012.02.0146.
EndNote Şengül C, Sünbül A, Semiz E, Dindar İ (June 1, 2012) Left ventricular microfistulization: A rare cause of ischemia in a patient with normal coronary arteries. Dicle Tıp Dergisi 39 2 299–301.
IEEE C. Şengül, A. Sünbül, E. Semiz, and İ. Dindar, “Left ventricular microfistulization: A rare cause of ischemia in a patient with normal coronary arteries”, diclemedj, vol. 39, no. 2, pp. 299–301, 2012, doi: 10.5798/diclemedj.0921.2012.02.0146.
ISNAD Şengül, Cihan et al. “Left Ventricular Microfistulization: A Rare Cause of Ischemia in a Patient With Normal Coronary Arteries”. Dicle Tıp Dergisi 39/2 (June 2012), 299-301. https://doi.org/10.5798/diclemedj.0921.2012.02.0146.
JAMA Şengül C, Sünbül A, Semiz E, Dindar İ. Left ventricular microfistulization: A rare cause of ischemia in a patient with normal coronary arteries. diclemedj. 2012;39:299–301.
MLA Şengül, Cihan et al. “Left Ventricular Microfistulization: A Rare Cause of Ischemia in a Patient With Normal Coronary Arteries”. Dicle Tıp Dergisi, vol. 39, no. 2, 2012, pp. 299-01, doi:10.5798/diclemedj.0921.2012.02.0146.
Vancouver Şengül C, Sünbül A, Semiz E, Dindar İ. Left ventricular microfistulization: A rare cause of ischemia in a patient with normal coronary arteries. diclemedj. 2012;39(2):299-301.