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Published on: July 11, 2019
Multiple multilateral coronary-cameral fistulae in a patient with minor cardiac venous system
Darko Markota1, Zrinko Prskalo1, Ivica Markota1
1Department of Cardiology, University Hospital Mostar, Bijeli Brijeg bb, 88000 Mostar, Bosnia and Herzegovina.
Insights
A rare case of coronary artery fistulae, abnormal heart vessel connections, was diagnosed after a patient experienced chest pain post-gallbladder surgery. This finding highlights the importance of thorough cardiac evaluation in post-operative patients.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Diagnostic Imaging
Background:
- Coronary artery fistulae are uncommon congenital or acquired abnormalities.
- Post-operative complications can sometimes manifest with cardiac symptoms.
Purpose of the Study:
- To report a rare case of extensive coronary artery fistulae presenting with ischemic symptoms after laparoscopic surgery.
- To highlight the diagnostic utility of coronary angiography and CT in identifying complex coronary anomalies.
Main Methods:
- Case report of a 40-year-old male with chest pain and ECG changes post-cholecystectomy.
- Diagnostic coronary angiography to visualize coronary artery anatomy.
- Multislice computed tomography (MSCT) to assess cardiac venous structures.
Main Results:
- Coronary angiography revealed multiple fistulae from LAD, Cx, and RCA to the left ventricle.
- MSCT demonstrated a hypoplastic coronary sinus and underdeveloped cardiac venous system.
- Patient presented with symptoms suggestive of myocardial ischemia.
Conclusions:
- Coronary artery fistulae can present atypically, even in the post-operative period.
- A comprehensive cardiovascular workup is crucial for patients with unexplained chest pain.
- Associated venous anomalies may influence the clinical presentation and management of coronary fistulae.
Abstract:
A 40-year-old man was hospitalized in the coronary care unit with chest pain and abnormal electrocardiogram. Twenty days earlier, the patient underwent laparoscopic gallbladder surgery. Due to chest pain and ischemic ECG changes, patient was subjected to coronary angiography. The selective coronary angiography revealed multiple multilateral fistulae arising from the left anterior descending artery, circumflex artery, and the right coronary artery draining to the left ventricle. Multislice computed tomography showed hypoplastic coronary sinus and minor cardiac venous system.
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