Fístula coronariana para ventrículo esquerdo: diagnóstico por tomografia computadorizada

Abstract

Coronary artery fistulas are rare and are most often diagnosed by echocardiography or by cine-angiocardiography. However, the computed tomography angiography (CTA) of coronary arteries has been gaining ground. The incidence of this disease is very low, with a more frequent occurrence of fistulas originating in the right coronary artery. There is a higher incidence of coronary artery fistulas to right heart chambers, with coronary artery fistulas to the left ventricle (LV) being rare. Treatment can be surgical or percutaneous.This report describes a case of coronary fistula to left ventricle diagnosed by CT angiography of coronary arteries in a hypertensive and asymptomatic 46-year-old male, who was tested positive for ischemia in an exercise test. The CT angiography ruled out coronary obstructive disease, but it revealed a coronary fistula to the left ventricular cavity. Coronary Fistula to the Left Ventricle: Assessed by Computed Tomography Case reportIt refers to a 46-year-old, obese, hypertensive and dyslipidemic male patient. In the physical examination, the patient's heart rate was regular at three different stages and the BP was 160 x 100 mmHg. At the outpatient clinic, in the examination for coronary artery disease (CAD), the patient was asymptomatic.The ischemic test result obtained by means of an exercise test was positive. Therefore, in order to rule out CAD, a CT angiography of the coronary arteries was carried out and it revealed markedly dilated and tortuous coronary arteries, besides a large fistula connecting the anterior descending artery to the right coronary artery and a single confluence for the LV cavity adjacent to the posterior mitral valve leaflet (Figures). MethodsThe examination and clinical history of the patient in the digital archive of images (PACS) were reviewed. The patient's authorization to use the images for a case report was obtained.The equipment used was manufactured by Philips Medical Systems -model Brilliance 16-MDCT.With the patient lying on his back, in respiratory pause (apnea of 15 seconds), in electrocardiographic (ECG) synchronization, 0.75-mm thick tomographic slices of the heart were obtained by using 80 ml of nonionic iodinated contrast (Optiray 350 mg/ml) in an infusion pump at 5 ml/ second, followed by 40 ml of 0.9% saline solution, at the same infusion rate. The images were viewed in the workstation from Philips Medical Systems, Brilliance CT model. Multiplanar reconstructions (MPR), curved multiplanar reconstructions (Curved MPR) and 3D reconstructions with volume rendering technique (VR) were performed (Figures 1 and 2).

Coronary–Cavitary Fistula of the Circumflex Coronary Artery to the Left Atrium as a Probable Etiology of Heart Failure: A Case Report

“…4 Its incidence among congenital heart diseases is low, totaling only 0.2%-0.4%, with the congenital origin being more common than the acquired one. 1 Epidemiologically, right CFs are the most frequent (50%-70% of cases), but they may also occur in the left coronary artery or both arteries. 1 Drainage usually occurs into low-pressure chambers.…”

“…Coronary fistulas (CF) are direct connections from one or more coronary arteries to cardiac chambers or great vessels. 1 They originate from the right coronary artery in up to 50% of cases and from the left anterior descending artery in 42% of cases. Drainage usually occurs into low-pressure chambers, most commonly the right ventricle (41%), right atrium (26%), or pulmonary artery (15%-17%).…”

“…2 Congenital anomalies are more prevalent than acquired anomalies, being found on up to 0.2% of routine coronary angiographies. 1 Most patients are asymptomatic, but they can present with fatigue, dyspnea on exertion, palpitations, and angina. Continuous heart murmurs can be heard.…”

“…Continuous heart murmurs can be heard. 1,2 The complementary electrocardiography findings are usually normal, although they may present characteristics of left atrial overload and ischemic changes. Diagnosis is usually made by echocardiography, especially when the involved coronary artery is dilated or in the presence of high-output coronary flow.…”

Fistula between the right coronary artery and the branch of the pulmonary artery as an uncommon cause of syncope in elderly patients

“…10 Atualmente, não existem guidelines específicos que ditem a conduta terapêutica. O que encontramos na literatura são publicações que sugerem que o tratamento seja estabelecido de acordo com o diâmetro do defeito e o fluxo, visando a prevenção de doença coronária do vaso afetado.…”