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[Left to right shunt for congenital coronary arterio-venous fistulas]
Insights
Congenital coronary artery fistulas are rare heart defects. This case highlights three fistulas in an asymptomatic child, detected via heart murmur.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Congenital coronary artery fistulas (CCAFs) are uncommon cardiac malformations.
- CCAFs can lead to serious complications like heart failure and pulmonary hypertension.
- Spontaneous closure of CCAFs can occur, but monitoring is crucial.
Observation:
- A 10-year-old asymptomatic male presented with an incidental heart murmur.
- Diagnostic imaging revealed three distinct coronary artery fistulas.
- Two fistulas originated from the left coronary artery, draining into the right ventricle.
- One fistula originated from the right coronary artery, draining into the pulmonary artery trunk.
Findings:
- The patient was asymptomatic despite the presence of multiple coronary artery fistulas.
- Doppler echocardiography and angiography confirmed the diagnosis and anatomical details.
- The specific drainage patterns into the right ventricle and pulmonary artery were identified.
Implications:
- Early detection of CCAFs, even in asymptomatic individuals, is vital.
- Understanding fistula anatomy aids in surgical or interventional planning.
- This case underscores the importance of echocardiography and angiography in diagnosing CCAFs.
Abstract:
Congenital coronary artery fistulas are rare malformations that may evolve to pulmonary hypertension, heart failure and myocardial ischemia, although some may close spontaneously. Complications such as endocarditis, rupture, aneurysm or thrombosis may also be observed. Most patients are asymptomatic and the fistulas are usually detected by doppler echocardiography and angiography. We report the case of an asymptomatic 10-year-old male who was submitted because he of a heart murmur, and three coronary fistulas were diagnosed. Two originated in the left coronary artery draining into the right ventricle and the other origin was in the right coronary artery draining into the pulmonary artery trunk.