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[Postoperative iatrogenic left coronaroventricular fistula. Demonstration by color two-dimensional Doppler]
A Marek1, J L Rey, C Tribouilloy
1Département de cardiologie, CHRU Sud, Amiens.
Insights
A rare coronary artery-left ventricular fistula was found 6 years after aortic valve replacement. This iatrogenic fistula, likely caused during surgery, was small and managed with echocardiographic follow-up.
Area of Science:
- Cardiology
- Cardiac Surgery
- Diagnostic Imaging
Background:
- Aortic valve replacement (AVR) is a common cardiac surgery.
- Coronary artery anomalies are rare but can lead to significant complications.
- Iatrogenic fistula formation is a potential, albeit uncommon, surgical complication.
Observation:
- A 67-year-old asymptomatic patient developed a coronary artery-left ventricular fistula 6 years post-AVR.
- Preoperative coronary angiography showed normal coronary arteries, suggesting a later development.
- Doppler color flow mapping identified the fistula between a septal branch and the left ventricle.
Findings:
- The fistula was likely iatrogenic, possibly from needle insertion during ventricular purging in surgery.
- Echocardiography revealed a small fistula with a narrow Doppler color jet.
- Absence of significant left ventricular dilatation and aortic isthmus signal suggested a hemodynamically insignificant fistula.
Implications:
- This case highlights a rare delayed complication following aortic valve replacement.
- Doppler echocardiography is crucial for diagnosing and monitoring such iatrogenic fistulas.
- Conservative management with serial echocardiography may be appropriate for small, asymptomatic coronary artery-left ventricular fistulas.
Abstract:
The authors report the case of an asymptomatic 67 year old patient, in whom, 6 years after aortic valve replacement, Doppler color flow mapping showed the presence of a coronary artery--left ventricular fistula. The normality of preoperative coronary angiography suggested that this fistula was created during peroperative left ventricular purging: the implantation of a needle through the right ventricle and interventricular septum. A iatrogenic lesion of a septal branch probably caused the communication between the left anterior descending artery and the left ventricle. Postoperative normalisation of the left ventricular end diastolic dimension, the absence of dilatation of the left main coronary on 2D echocardiography, the narrowness of the Doppler color jet and the absence of a significant end diastolic Doppler signal in the aortic isthmus indicated a fistula of small size and simple Doppler echocardiographic follow-up was decided upon.