Miyokardiyal İskemi Oluşturan ve Sol Ventrikülografiyi Taklit Eden Kalıcı Tebesian Venlerin Ciddi Formu

Year 2021, , 178 - 179, 30.06.2021

Mustafa Serkan Karakaş Veysel Tosun Necmettin Korucuk Ünal Güntekin , Remzi Yılmaz

https://doi.org/10.15321/GenelTipDer.2021.309

Abstract

Koroner arter fistülü nadir bir konjenital anomalidir. Hastaların çoğu asemptomatik olmakla birlikte bazı hastalar semptomatik olabilmekte ve miyokardiyal iskemi, tromboz ve emboli, kalp yetmezliği ve aritmilerle gelebilmektedir. yazımızda efor dispnesi ve anginası bulunan ve miyokard perfüzyon sintigrafisinde geri dönüşlü inferior ve apikal defekt satanan 70 yaşında erkek sunulmuştur. Koroner anjiografide koroner darlık saptanmadı ancak sol ön inen arter, sirkümfleks arter ve sağ koroner arterden çoklu mikrofistüller aracılığıyla sol ventriküler kaviteye boşalan ve sol ventrikülografi görüntüsü oluşturan kapiller boyanma izlendi. Küçük mikrofistüllerden dolayı hastaya medikal tedavi verildi, beta bloker, aspirin ve ranolazin tedavisi ile taburcu edildi. Bir ay sonraki kontrolde hasta yakınmalarında azalma olduğunu belirtti.

Keywords

Tebesian ven, koroner arter fistülü, miyokardiyal iskemi

Severe Form of Persistent Thebesian Veins Mimicking Left Ventriculography Presenting with Myocardial Ischemia

Abstract

Coronary artery fistula is a rare congenital anomaly. Most patients with this anomaly are asymtomatic, but some patients may be symtomatic and have a presentation of myocardial ischemia, thrombosis and embolism, heart failure, arrhytmias. We present a 70-year-old male with exertional dyspnea and angina whose myocardial perfusion scintigraphy demonstrated inferior and apikal defect with complete reversibility. Coronary angiograpyh showed no coronary stenosis, but capillary blush draining into the left ventricular cavity through multiple microfistulas from the left anterior descending artery, circumflex artery and right coronary artery mimicking left ventriculography. Because of these small microfistulas, patient managed medically, he was discharged on a beta blocker, aspirin and ranolazine therapy. He stated a reduction in his symptoms one month later.

Keywords

Thebesian veins, coronary artery fistula, myocardial ischemia

References

• Stierle U, Giannitsis E, Sheikhzadeh A, Portraz J et al. Myocardial ischemia in generalized coronary artery-left ventricular microfistulae. Int J Cardiol 1998;63:47-52.
• Alkhulaifi AM, Horner SM, Pugsley WB, Swanton RH et al. Coronary artery fistulas presenting with bacterial endocarditis. Ann Thorac Surg 1995; 60:202-4.
• Skimming JW, Walls JT. Congenital coronary artery fistula suggesting a steal phenomenon in a neonate. Pediatr Cardiol 1993;14:174-5.
• Chattopadhyay S, Wahab N, O’Reilly K. Persistent thebesian veins presenting with myocardial ischemia. Can J Cardiol 2010;26:e31-2.
• Ashraf SS, Shaukat N, Fisher M, Clarke B. Bicoronary-pulmonary fistulae with coexistent mitral valve prolapse: A case report and literature review of coronary-pulmonary fistula. Eur Heart J 1994;15:571–4.
• Vlodaver Z, Neufeld H, Edwards J. Coronary arterial variations in the normal heart and in congenital heat disease. London: Academic Press, Inc.; 1975 43–78.
• Luo L, Kebede S, Wu S, Stouffer GA. Coronary artery fistulae. Am J Med Sci 2006;332:79–84.
• Ata Y, Turk T, Bicer M, Yalcin M, et al. Cononary arteriovenous fistulas in the adults: natural history and management strategies. J Cardiothorac Surg 2009;4:62
• Mechleb W, Abboud L, Mattar C, Haddadin T. Case report and review of literature: coronary artery fistulae. Tenn Med 2013;106:39–41
• Stierle U, Giannitsis E, Sheikhzadeh A, Potratz J. Myocardial ischemia in generalized coronary artery-left ventricular microfistulae. Int J Cardiol 1998;63:47-52.
• Valente AM, Lock JE, Gauvreau K, et al. Predictors of long-term adverse outcomes in patients with congenital coronary artery fistulae. Circ Cardiovasc Interv 2010;3:134-9.
• Blake HA, Manion WC, Mattingly TW, Baroldi G. Coronary artery anomalies. Circulation 1964;30:927-40.
• Abelin AP, Sarmento-Leite R, Quadros AS, Gottschall CAM. Fistula coronaria. Rev Bras Cardiol Invas. 2008;16:242–243.
• Khoueiry G, Baydoun H, Abi Rafeh N, McCord D, et al. Persistant thebesian vessels involving the right and left ventricles leading to coronary steal phenomena and ischemia. Congenit Heart Dis. 2014;9(2):E61-5.