Association of coronary to left ventricular microfistulae (vessels of Wearn) with atrial septal defect in an adult without cyanotic heart disease

Abstract

Vessels of Wearn are rare findings during coronary angiography in adults. They are known to be associated with forms of cyanotic congenital heart disease in infants but we are not aware of any published cases of association with non-cyanotic left to right shunts in adults. We present the case of a 69-year-old man with angiographically evident vessels of Wearn draining from the left and right coronary arteries into the left ventricle associated with an asymptomatic atrial septal defect. We postulate a developmental phase association between atrial septal maturation and closure of perfusing microchannels from the ventricular cavities to the epicardial coronary arteries on the same spectrum as that which leads to more widespread defects in infants. We also highlight a common medication side effect that might have been mistaken as a manifestation of the congenital anomalies.

Forgotten knowledge of the coronary-cameral connections and the rediscovery of their dynamic nature in development: The result of a misnomer, ambiguous use of nomenclature, and varied evaluation methods

“…6 Thebesius did not study the arterioluminal connections, and the arterioluminal connections are not veins ( Figure 1). 3,5,[7][8][9][10][11][12] The authors appear not to have translated the original works of either Vieussens or Thebesius as Wearn has done, 1,9 and thus inferred from an inaccurate source 6 that both Vieussens and Thebesius studied thebesian veins.…”

“…8,9 The eponym "vessels of Wearn" has been offered to describe those thebesianlike vessels on the arterial side of the capillary bed. 3,5,10,11 Regardless of whether the eponym is adopted, the medical and scientific community would be well served if a consistent terminology was agreed upon.…”