Coronary Artery Aneurysm and Coronary Fistula in Tetrology of Fallot: A Case Presentation of A Young Adult Undergoing Total Correction

Öz

Congenital presentation of a coronary artery fistula is a rarely observed pathologic finding; especially an association with tetralogy of Fallot is reported in only three cases previously. This is a presentation of a patient with tetralogy of Fallot who had an aneurysmatic fistula communication between the circumflex artery and left ventricle. Preoperative computerized tomography angiographic examination showed a communication between the circumflex artery and left ventricle. 27-year-old female patient underwent an operation for total correction. Intraoperatively, the fistula could not be seen and it had been left unligated. The patient had been discharged from hospital without problems on the tenth postoperative day. Aneurysmatic coronary artery fistula is not found to cause a deleterious effect on the hemodynamics or myocardial performance of the heart after the total correction surgery

Anahtar Kelimeler

• Coronary artery; aneurysm; coronary fistula.

Fallot Tetrolojisinde Koroner Arter Anevrizmas› ve Koroner Fistul: Tam Düzeltme Yap›lan Genç Eriflkin Bir Vaka Sunumu

Öz

Konjenital koroner arter fistülü oldukça nadir gözlenen bir patolojik bulgudur. Özellikle Fallot tetralojisi ile birlikteli¤ i ise daha önce sadece üç vaka olarak rapor edilmifltir. Bu yaz›m›zda sircumflex arter ile sol ventrikül aras›nda fistül bulunan fallot tetrolojili bir hastan›n sunumu yap›lmaktad›r. Ameliyat öncesi bilgisayarl› tomografik anjiografide sol ventrikül ile sircumflex arter aras›nda anevrizmatik fistül iliflkisi gözlemlendi. 27 yafl›ndaki bayan hasta tam düzeltme ameliyat›na al›nd›. Operasyonda fistül bulunamad› ve ba¤lanmadan b›rak›ld›. Problemi olmayan hasta, ameliyat sonras› onuncu günde taburcu edildi. Anevrizmatik koroner arter fistülün tam düzeltme ameliyat› sonras› nda miyokardiyal performansda ve hemodinamide bozulma yaratan bir etkisi gözlemlenmedi.

Anahtar Kelimeler

• Fallot tetralojisi; koroner arter; anevrizma; koroner fistül.

Kaynakça

1. Said SM, Thiadens AH, Fieren VM Meijoboom EJ, Van der Werf TT, et al. Coronary artery fistulas. Neth Heart J. 2002;10:65-78
2. Hirose H, Amano A, Yoshida S, Nagao T, Sunami H, Taka- hashi A, et al. Coronary artery aneurysm associated with fistu- la in adults: collective review and a case report. Ann Thorac Cardiovasc Surg. 1999; 5(4):258–64
3. Saxena A, Sharma S, Shrivastatava S. Coronary arterioveno- us fistula in tetralogy of Fallot: An unusual association. Int J Cardiol. 1990; 28(3):373-4
4. Gumbiene L, Karalius R. Congenital coronary artery anoma- lies in patients with tetralogy. Medicina (Kaunas). 2002; 38 suppl 2:191-3.
5. Bonnet C, Agnoletti G, Boudjemline Y, Iserin L, Bonnet D, Si- di D. Coronary Fistula in tetralogy of Fallot. A rare complicati- on of embolisation. Arch Mal Coeur Vaiss. 2004; 97(5):558–6
6. Wank NK, Hsieh LY, Shen CT, Lin YM. Coronary arteriove- nous fistula in pediatric patients: a 17 year institutional experi- ence. J Formos Med Assoc. 2002; 101(3):177–82.
7. Koifman B, Egdell R, Somerville J. Prevelance of asympto- matic coronary arterial abnormalities detected by angiography in grown-up patients with congenital heart disease. Cardiol Young 2001; 11: 614-18.
8. Datta J, White CS, Gilkeson RC, Meyer CA, Kansal S, Jani ML, et al. Anomalous coronary arteries in adults: depiction at multidetector row CT angiography. Radiology 2005; 235:812-8. 99.. Hoffmann MH, Shi H, Schmid FT, Gelman H, Brambs HJ, Aschoff AJ. Noninvasive coronary imaging with MDCT in com- parison to invasive conventional coronary angiography: a fast- developing technology. Am J Roentgenol 2004; 182:601-8.

9. Dabizzi RP, Teodori G, Barletta GA, Caprioli G, Baldrighi G, Baldrighi V. Associated coronary and cardiac anomalies in the tetralogy of Fallot. An angiographic study. Eur Heart J. 1990; 11: 692-704.
10. Badak O, Akdeniz B, Aslan O, Kirimli O, Göldeli O, Güneri S. A fistula connecting the right coronary artery to the right at- rium: A hitherto undescribed association. Can J Cardiol. 2000; 16: 3, 386–88.
11. Saxena P, Konstantinov I, Burstow D, Tam R. Surgical re- pair of a large coronary artery aneurysm with arteriovenous fis- tula. J Thorac Cardiovasc Surg. 2006;131(5):1167–8.
12. Ito H, Kamiyama T, Nakamura W, Segawa K, Takahashi K, Iijima T, et al. Coronary artery pulmonary artery fistula origina- ting from three major coronary branches associated with exer- tional chest pain and tachycardia-dependent left bundle branch block. Jpn Heart J. 1998; 39(2):247–53
13. Coronary Artery Aneurysm and Coronary Fistula in Tetrology ... 25