A Rare Association in Coronary Artery Fıstula: Vieussens Arterial Ring

Abstract

Coronary angiography is the best method for the diagnosis of coronary artery fistula. Treatment of asymptomatic coronary-pulmonary fistulas varies according to fistula size, patient age, presence of symptoms, and the profit/loss balance of the interventional procedure. These patients, who are usually asymptomatic, are diagnosed incidentally during coronary computed tomographic angiography or invasive coronary angiography. In the case report, it was aimed to show the rare association of Vieussens ring and pulmonary fistula. In this case report, an 82-year-old female patient with exertional dyspnea, hypertension, atrial fibrillation and type 2 diabetes mellitus was included in the study. In the physical examination of the patient, a 3/6 systolic murmur was detected on cardiac auscultation. In the electrocardiography of the patient, atrial fibrillation rhythm was observed at an average heart rate of 80/min. In the coronary angiography of the patient, the main coronary distal plaque, left anterior proximal plaque, normal circumflex and normal right coronary artery were observed. It was observed that developed collaterals originating from the diagonal artery and optus marginal artery extending to the pulmonary artery and collaterals originating from the right coronary artery conus branch anastomose (Vissuens arterial ring) with collaterals extending to the pulmonary arteries.

Keywords

• angiography
• coronary
• fistula
• pulmonary
• vieussens

Koroner Arter Fistülünde Nadir Bir Birliktelik: Vieussens Arterial Halka

Öz

Koroner arter fistülü tanısı için koroner anjiyografi en iyi yöntemdir. Asemptomatik koroner-pulmoner fistüllerde tedavi fistül boyutuna, hasta yaşına, semptom varlığına ve girişimsel işlemin kar/zarar dengesine göre değişmektedir. Genellikle asemptomatik olan bu hastalar koroner bilgisayarlı tomografik anjiyografi veya invaziv koroner anjiyografi esnasında rastlantısal olarak tanı alırlar. Bu vaka sunumunun amacı, Vieussens halkası ve pulmoner fistülün nadir birlikteliğini göstermektir. Bu vaka sunumuzda, efor dispnesi şikayeti ile hipertansiyonu, atrial fibrilasyonu ve tip-2 diabetes mellitus olan 82 yaşında bir kadın hasta çalışmaya alınmıştır. Hastanın fiziksel muayenesinde kardiyak oskültasyonda 3/6 sistolik üfürüm saptandı. Hastanın elektrokardiyografisinde, ortalama 80/dk kalp hızında atrial fibrilasyon ritminin olduğu görüldü. Hastanın koroner anjiyografisinde ana koroner distali plaklı, sol anterior proksimal plaklı, sirkumfleks normal, sağ koroner arter normal izlendi. Diagonal arter ve optus marjinal arterden köken alıp pulmoner artere uzanan gelişmiş kollateraller ile sağ koroner arter konus dalından köken alan kollaterallerin pulmoner arterlere uzanan kollaterallerle anastomoz (Vissuens arteryel halka) yaptığı izlendi.

Anahtar Kelimeler

• anjiografi
• fistül
• koroner
• pulmoner
• vieussens

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