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ANJİYOGRAFİDE ABARTILI NEOVASKÜLARİTE İLE KENDİNİ GÖSTEREN VE SOL ATRİYUMA DRENAJ YERİ ATİPİK OLAN BİR KORONER-KAMERAL FİSTÜL OLGUSU

Year 2013, Volume: 14 Issue: 3, 39 - 41, 01.12.2013

Abstract

GİRİŞ: Bir koroner arterle bir kalp boşluğu arasında miyokardiyal kapiller yatağı köprüleyerek oluşmuş belirgin bağlantı koroner-kameral fistül olarak tanımlanır. Mitral darlık hastalarında, sirkumfleks koroner arterden köken alan fistül ve koroner revaskülarizasyon varlığı, sol atriyal trombüsün bir belirtisidir.OLGU: 51 yaşında eski bir maden işçisi olan erkek hasta hastanemize nefes darlığı ve atipik göğüs ağrısı yakınmaları ile başvurdu. Transtorasik ekokardiyografide mitral darlık ve sol atriyumda trombüs tespit edildi. Transözefajeal ekokardiyografide trombüsün sol atriyum apendiksinden köken alarak interatriyal septum ve atriyum tabanına doğru uzanım gösterdiği gözlemlendi. Koroner anjiyografide sirkumfleks koroner arterden çıkan ve sol atriyum içindeki kitle lezyonuna drene olan yaygın damar ağı görüldü. Hastaya mitral kapak ve koroner-kameral fistülün kapatılmasına yönelik cerrahi planlandı. Operasyonda, atriyum tabanından başlayarak sağ pulmoner ven ağzı seviyesinden interatriyal septum ve mitral kapak anülüsü seviyesine kadar olan mesafeyi kaplayan dev trombüs saptandı. Trombüs dikkatli bir şekilde atriyum duvarından diseke edilerek ayrıldı. Trombüsün altında posterior mitral anülüsten yaklaşık 2-2,5 cm mesafede –süperior pulmoner venler ve atriyal apendiks arasındaki hattın orta noktasında– yerleşimli olan koroner-kameral fistül ostiumu bulundu. Ostium primer olarak sütüre edildi ve mitral kapak replase edildi. SONUÇ: Mitral darlık olgularında sol atriyal trombüse eşlik eden koroner-kameral fistüller değişik şekillerde ortaya çıkabilmektedir. Bu tip koroner-kameral fistüller en sık atriyal apendikse drene olmakla birlikte, fistülün açıldığı yerin kesin olarak saptanabilmesi için sol atriyumun diğer bölgeleri de dikkatli bir şekilde incelenmelidir

References

  • 1. Padfield GJ. A case of coronary cameral fistula. Eur J Echocardiogr 2009;10:718-20.
  • 2. Qureshi SA. Coronary arterial fistulas. Orphanet J Rare Dis 2006;21;1:51.
  • 3. Yılmaz H, Başarıcı İ, Demir İ. Nadir bir iskemi nedeni: Kongenital pleksiform koroner arter-kameral fistül. Turkiye Klinikleri J Cardiovasc Sci 2006;18:158-61.
  • 4. López-Candeles A, Kumar V. Coronary artery to left ventricle fistula. Cardiovasc Ultrasound 2005;3:35.
  • 5. Zoghbi E, Seif F, Obeid M, Abou Nader G, Sawaya J. A young female with unusual cause of dyspnea. Int J Cardiol 2007;122:21-22.
  • 6. Thomas M, Davis RC. Asymptomatic extensive coronary cameral fistulae involving the left ventricle. Can J Cardiol 2008;24:e46.
  • 7. Lo PH, Chua S, Fu M, Yeh KH, Kyo S, Hung JS. Contrast transesophageal demonstration of coronary artery fistula within left atrial appendage thrombus in mitral stenosis. J Am Soc Echocardiogr 1992;5:471-4.
  • 8. Sharma S, Kumar MV, Reddy VM, Kaul U, Rajani M, Venugopal P. Left coronary angiography in the preoperative diagnosis of thrombosis of the left atrium or its appendage in rheumatic mitral stenosis. Clin Radiol 1990;42:188-91.
  • 9. Russo G, Tamburino C, Ali A, Monaco O, Calvi V, Drago A, Cinnirella C, Abbate M, Giuffrida G. Diagnosis of left atrial thrombi in mitral valve disease by coronary arteriography. Cathet Cardiovasc Diagn 1990;21:82-5.
  • 10. Hoffman JI. Congenital anomalies of the coronary vessels and the aortic root. In: Emmanoulides GC, Riemenschneider TA, Allen HD, Gutgesell HP, editors. Heart disease in infants, children and adolescents. Baltimore: Williams and Wilkins; 1995. p. 780.
  • 11. Said SA, van der Werf T. Acquired coronary cameral fistulas: are these collaterals losing their destination? Clin Cardiol 1999;22:297-302.
  • 12. Arslan S, Gurlertop Y, Elbey MA, Karakelleoglu S. Multiple coronary-cameral fistulae causing angina pectoris. Tex Heart Inst J 2009;36:622-3.

A Coronary Cameral Fistula Displaying Exaggerated Neovascularity on Angiogram with Atypical Drainage Site in Left Atrium

Year 2013, Volume: 14 Issue: 3, 39 - 41, 01.12.2013

Abstract

OBJECTIVE: The term coronary cameral fistula describes a sizeable communication between a coronary artery and a chamber of the heart that bypasses the myocardial capillary bed. In patients with mitral stenosis, coronary revascularization and fistula originating from the circumflex coronary branch is an indicator of left atrial thrombus. CASE: A 51-year-old male who was a former coal miner admitted to our hospital with complaints of shortness of breath and atypical chest pain. Transthoracic echocardiography revealed mitral stenosis and left atrial thrombus. Transesophageal echocardiography showed that the thrombus was spreading out from the left atrial appendix towards the interatrial septum and the base of atrium. Coronary angiogram revealed extensive network of vessels arising from the circumflex coronary artery draining into a solid lesion originating from left atrium. He was scheduled to undergo mitral valve surgery and surgical closure of the coronary cameral fistula. In the operation, giant thrombus extending from the base of atrium to the origin of the right pulmonary vein and down to the interatrial septum and mitral valve annulus was detected. Thrombus was carefully dissected and peeled off from the left atrial wall. Underneath the thrombus –situated at the center of the line between the superior pulmonary veins and atrial appendage– approximately 2-2,5 cm. distant from the posterior mitral annulus, ostium of the coronary cameral fistula was found. The ostium was closed by simple sutures and the mitral valve was replaced. CONCLUSION: Coronary cameral fistulas accompanying left atrial thrombus in cases of mitral stenosis may emerge in variable forms. Although the most common drainage site for these fistulas is atrial appendage, the other regions of left atrium should be carefully inspected for exactly localizing the ostium of the fistula.

References

  • 1. Padfield GJ. A case of coronary cameral fistula. Eur J Echocardiogr 2009;10:718-20.
  • 2. Qureshi SA. Coronary arterial fistulas. Orphanet J Rare Dis 2006;21;1:51.
  • 3. Yılmaz H, Başarıcı İ, Demir İ. Nadir bir iskemi nedeni: Kongenital pleksiform koroner arter-kameral fistül. Turkiye Klinikleri J Cardiovasc Sci 2006;18:158-61.
  • 4. López-Candeles A, Kumar V. Coronary artery to left ventricle fistula. Cardiovasc Ultrasound 2005;3:35.
  • 5. Zoghbi E, Seif F, Obeid M, Abou Nader G, Sawaya J. A young female with unusual cause of dyspnea. Int J Cardiol 2007;122:21-22.
  • 6. Thomas M, Davis RC. Asymptomatic extensive coronary cameral fistulae involving the left ventricle. Can J Cardiol 2008;24:e46.
  • 7. Lo PH, Chua S, Fu M, Yeh KH, Kyo S, Hung JS. Contrast transesophageal demonstration of coronary artery fistula within left atrial appendage thrombus in mitral stenosis. J Am Soc Echocardiogr 1992;5:471-4.
  • 8. Sharma S, Kumar MV, Reddy VM, Kaul U, Rajani M, Venugopal P. Left coronary angiography in the preoperative diagnosis of thrombosis of the left atrium or its appendage in rheumatic mitral stenosis. Clin Radiol 1990;42:188-91.
  • 9. Russo G, Tamburino C, Ali A, Monaco O, Calvi V, Drago A, Cinnirella C, Abbate M, Giuffrida G. Diagnosis of left atrial thrombi in mitral valve disease by coronary arteriography. Cathet Cardiovasc Diagn 1990;21:82-5.
  • 10. Hoffman JI. Congenital anomalies of the coronary vessels and the aortic root. In: Emmanoulides GC, Riemenschneider TA, Allen HD, Gutgesell HP, editors. Heart disease in infants, children and adolescents. Baltimore: Williams and Wilkins; 1995. p. 780.
  • 11. Said SA, van der Werf T. Acquired coronary cameral fistulas: are these collaterals losing their destination? Clin Cardiol 1999;22:297-302.
  • 12. Arslan S, Gurlertop Y, Elbey MA, Karakelleoglu S. Multiple coronary-cameral fistulae causing angina pectoris. Tex Heart Inst J 2009;36:622-3.
There are 12 citations in total.

Details

Other ID JA92HG43YE
Journal Section Case Report
Authors

Uğur Gürcün This is me

Tünay Kurtoğlu This is me

Çağdaş Akgüllü This is me

Ufuk Eryılmaz This is me

Publication Date December 1, 2013
Published in Issue Year 2013 Volume: 14 Issue: 3

Cite

EndNote Gürcün U, Kurtoğlu T, Akgüllü Ç, Eryılmaz U (December 1, 2013) A Coronary Cameral Fistula Displaying Exaggerated Neovascularity on Angiogram with Atypical Drainage Site in Left Atrium. Meandros Medical And Dental Journal 14 3 39–41.