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[Silent coronary artery-left ventricular fistula and acute myocardial ischemia]
R C de Lacerda1, F M Albanesi Filho, J P Soares
1Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro.
Insights
A rare silent coronary fistula caused severe heart problems in a patient without blockages. This unusual coronary artery drainage to the left ventricle may explain myocardial ischemia via the coronary steal phenomenon.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Diagnostic Imaging
Background:
- Coronary artery disease (CAD) is a leading cause of myocardial ischemia.
- Papillary muscle dysfunction can result from ischemia, leading to heart failure.
- Obstructive CAD is the typical cause, but non-obstructive causes should be considered.
Abstract:
A 65-year-old woman developed severe coronary insufficiency associated with papillary muscle dysfunction. She was submitted to cineangiocoronarography which ruled out obstructive coronary disease. Coronarography revealed a communication between the coronary arteries and the left ventricle, but a coronary arterial fistula was not seen. The possibility of this uncommon form of coronary drainage to the left ventricle, named silent fistula, being the cause of myocardial ischemia related to the coronary steal phenomenon is discussed.