Coronary Artery to Pulmonary Artery Fistula With TWO Giant Saccular Aneurysms in an Elderly Patient Determined Noninvasively

Yamada, Yoshiaki; Sugino, Masakazu; Kishima, Genichi; Tanaka, Toshinari; Iwagaki, Akitaka; Negoro, Nobuyuki; Takada, Kiyoshi; Nakajima, Osamu

doi:10.1253/jcj.60.618

Cited by 4 publications

(3 citation statements)

References 11 publications

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“…Currently, CAFs and their anatomical morphology are increasingly being detected, non-invasively and invasively, due to the widespread application and availability of computed tomography scanning [7], multidetector computed tomography [8], cardiovascular magnetic resonance [9][10][11], transthoracic echocardiography [12], transoesophageal echocardiography (TEE) [13] and CAG [12,14,15]. The incidence is estimated at 0.1-0.4% of the adult coronary angiographic population [16,17].…”

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confidence: 99%

Gender-related differences in octogenarians with congenital coronary artery fistula: a report of two cases and a review

2011

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Aim To highlight gender-related differences in octogenarians with a congenital coronary artery fistula (CAF). Materials and methods We present two elderly female patients with a congenital fistula, a septuagenarian and a nonagenarian, and review the world literature between 1954-2010. Results The septuagenarian patient presented with easy fatigability and the nonagenarian patient with acute myocardial infarction contralaterally to the fistula. Coronary angiography (CAG) demonstrated a coronary-pulmonary artery fistula (CPF). The nonagenarian patient underwent percutaneous coronary intervention of the right coronary artery. CAG revealed a CPF associated with a huge multiple aneurysmal formation. Data from 57 mainly symptomatic patients with a mean age of 75.3 years (range 70-87 years) were collected. The cohort was subdivided into female (mean age 84.3 years) and male (mean age 75.2 years) subgroups and compared with each other. Multi-origin (bilateral and multilateral) was prevalent in females, 40% versus 12% in males. Aneurysmal formation was found in females and males in 40% and 18%, respectively. Ethnicity was 65% Caucasian and 35% Asian. Multi-origin fistulas were prevalent in the Asian (45%) compared with the Caucasian (11%) subset. Conclusions A septuagenarian and a nonagenarian female patient with congenital CAF are presented. On reviewing the literature, important differences were found between elderly females and males with congenital CAF.

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Section: Introductionmentioning

confidence: 99%

Gender-related differences in octogenarians with congenital coronary artery fistula: a report of two cases and a review

2011

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“…A few reported cases were detected after acute cardiac tamponade and were complicated by rupture of the aneurysm [1]. Other cases were detected coincidentally at coronary angiography [2][3][4]. Here, we present a rare case of two aneurysms from a coronary arterypulmonary artery fistula detected coincidentally by chest computed tomography (CT).…”

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confidence: 95%

“…However, these fistulas very rarely form aneurysms, and the exact incidence of the latter is unknown at present. Since all cases of coronary artery-pulmonary artery aneurysm reported to date involved Japanese patients [1,3,5], it is not clear whether such aneurysms also occur in other races; however, we suspect that there are race differences in the incidence.…”

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confidence: 99%

Formation of Two Aneurysms from a Coronary Artery-Pulmonary Artery Fistula

et al. 2004

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Coronary Arterial Fistula

2009

The Natural and Unnatural History of Congenital Heart Disease

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Congenital coronary artery fistula is a rare abnormality in which a branch of either coronary artery communicates with a cardiac chamber or with the pulmonary trunk. Recently Papaioannou and his colleagues (1962) reviewed 70 adequately documented cases, including one of their own; in 18 of these a branch of the right coronary artery entered the right ventricle. A further patient with this anomaly is described here, with observations on the problem of diagnosis and a possible surgical approach to the correction of the lesion. Case ReportA man, aged 31 when he died, was first seen at this hospital in 1957 six years previously, when he was admitted for a hernia operation. He had been attending a physician elsewhere and was known to have congenital heart disease, which was then symptomless. At no time did he have a continuous murmur.On examination, he had a collapsing pulse with capillary pulsation and a wide pulse pressure (blood pressure 150/45 mm. Hg). There was no cyanosis or clubbing and the venous pressure was normal. The heart was very large with hypertrophy of both ventricles. There was a very loud pan-systolic murmur, with thrill, maximal in the third intercostal space to the left of the sternum, an apical mid-diastolic murmur, and a soft blowing early-diastolic murmur down the left border of the sternum. The second sound was normally split. The electrocardiogram showed left ventricular hypertrophy, without ST or T wave changes but with notching of the R wave in leads I and V6 (Fig. la). On the chest radiograph there was enlargement of aorta and pulmonary trunk, and considerable pulmonary plethora. At cardiac catheterization, a large left-toright shunt at ventricular level was demonstrated (pulmonary/systemic flow ratio approximately 4:1), the pulmonary arterial pressure was slightly raised (35/7 mm. Hg above the sternal angle), and the pulmonary vascular resistance was normal. He was thought to have a ventricular septal defect with aortic regurgitation, but the discrepancy between the width of the pulse pressure and the inconspicuous early diastolic murmur was noted. Operation was not advised as he was then symptomless and as the presence of presumably free aortic reflux would have posed problems which at that time were insuperable.He was not seen again until five years later when he returned with increasing effort dyspncea and palpitation, and was found to have atrial fibrillation, with clinical and radiological evidence of pulmonary congestion. The signs were otherwise unchanged (phonocardiogram shown in Fig. lc), but the electrocardiogram now showed evidence of right ventricular hypertrophy (Fig. lb). The blood pressure was 170/30 mm. Hg. In spite of treatment his condition deteriorated, and he was readmitted to hospital with right and left ventricular failure, pulmonary infarction, and secondary chest infection. He never improved sufficiently for further investigations to be undertaken, and he died in May 1963.At necropsy (Dr. W. J. Hanbury) there was peripheral cedema, with pleural, pericardial, and p...

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Coronary Artery to Pulmonary Artery Fistula With TWO Giant Saccular Aneurysms in an Elderly Patient Determined Noninvasively

Cited by 4 publications

References 11 publications

Gender-related differences in octogenarians with congenital coronary artery fistula: a report of two cases and a review

Gender-related differences in octogenarians with congenital coronary artery fistula: a report of two cases and a review

Formation of Two Aneurysms from a Coronary Artery-Pulmonary Artery Fistula

Coronary Arterial Fistula

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