Related Experiment Videos
[Coronary ventricular fistulas in patients with heart transplants]
H P Dübel1, P Romaniuk, H Warnke
1Bereich Medizin (Charité), Humboldt-Universität zu Berlin.
Insights
Coronary artery-ventricular fistulas were found in two heart transplant patients. These fistulas may be linked to frequent right ventricular biopsies, suggesting a potential complication rate of 1.5%.
Area of Science:
- Cardiology
- Transplantation Medicine
- Interventional Cardiology
Background:
- Heart transplantation recipients undergo frequent monitoring.
- Coronary artery-ventricular fistulas are a rare complication.
Observation:
- Two out of ten heart transplant patients developed coronary artery-ventricular fistulas.
- Fistulas were observed between coronary arteries and cardiac ventricles.
Findings:
- In one patient, fistulas originated from the right coronary artery and left anterior descending artery.
- In the second patient, a fistula originated from the left anterior descending artery into the right ventricle.
- The fistulas remained stable in morphology and size over a two-month follow-up.
Implications:
- A potential complication rate of 1.5% is suggested if fistulas are linked to the high number of ventricular biopsies performed.
- Congenital presence of fistulas in donor hearts cannot be excluded as an alternative cause.
Abstract:
In detailed angiographic follow-up examinations in patients after heart transplantation, coronary artery-ventricular fistulas were observed in two of ten patients. In one patient, in the first postoperative year, 19 right ventricular biopsy procedures were performed obtaining a total of 71 tissue specimens and one year after transplantation, additionally, three specimens were obtained from the left ventricle. Coronary angiography demonstrated a fistula from the first anterior ventricular branch of the right coronary artery into the right ventricle (Figure 1) as well as a second smaller fistula between from a septal perforator of the left anterior descending artery into the left ventricle. At follow-up angiography two months later, the fistulas were unchanged in site and extent (Figure 2). Angiographically there was diffuse hypokinesis of the right ventricle and moderate tricuspid regurgitation. In the second patient, in the first year after transplantation, 20 right ventricular biopsy procedures were performed obtaining a total of 80 tissue specimens. One year after transplantation coronary angiography showed a fistula between a septal perforator of the left anterior descending artery into the right ventricle (Figure 3) which, two months later, was unchanged in morphology and, as in the first case, the size of the shunt was small. Angiographically, there was moderate tricuspid regurgitation and apical hypokinesis of the left ventricle. If a relationship between the fistulas and biopsies is postulated, from a total 196 biopsy procedures obtaining 748 tissue specimens, the rate of this complication would be calculated at 1.5%. It cannot be ruled out, however, that the fistulas had been congenitally present in the donor hearts.(ABSTRACT TRUNCATED AT 250 WORDS)