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Left ventricular inflow obstruction due to a coronary arteriovenous fistula: a paediatric case report
Ayako Chida-Nagai1, Hirokuni Yamazawa1, Takao Tsujioka1
1Department of Paediatrics, Hokkaido University Hospital, Kita 14, Nishi 5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan.
Insights
A rare coronary arteriovenous fistula (CAVF) caused left ventricular inflow obstruction in a child. Continued monitoring is crucial for potential complications even after surgical repair.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Coronary arteriovenous fistula (CAVF) is a rare condition.
- CAVF can lead to significant cardiovascular complications in infants and children.
Observation:
- A pediatric patient presented with left ventricular inflow obstruction due to a persistent CAVF.
- The abnormal vessel originated from the left circumflex coronary artery and encircled the mitral valve annulus.
- Progressive obstruction worsened over time, despite initial surgical intervention.
Findings:
- Persistent CAVF can cause progressive left ventricular inflow obstruction.
- The anatomical course of the fistula is critical in determining the risk of obstruction.
- Left-to-right shunting can lead to pulmonary congestion and right ventricular volume overload.
Implications:
- Long-term surveillance is essential for patients with CAVF, even after surgical closure.
- Early detection and management of progressive obstruction are vital to prevent heart failure.
- Understanding the specific fistula anatomy aids in predicting and managing potential complications.
Background:
We report a rare case of left ventricular inflow obstruction from a branch of the left circumflex coronary artery to the right atrium caused by a coronary arteriovenous fistula (CAVF) in a young Japanese male child.
Case Presentation:
The patient was diagnosed with CAVF following a heart murmur shortly after birth. The left-to-right shunt caused right ventricular volume overload and pulmonary congestion. An emergency surgical intervention was performed for the CAVF on day 6 after birth. However, by 5 years of age, his left ventricular inflow obstruction worsened. We found an abnormal blood vessel originating from the proximal part of a branch of the left circumflex coronary artery, circling the outside of the mitral valve annulus along the medial side of the coronary sinus. As the child gets older, the blood inflow into the left ventricle might get restricted further, resulting in left-sided heart failure.
Conclusion:
Our findings suggest that even after CAVF closure surgery, it is essential to monitor for complications caused by progressive dilatation of a persistent CAVF.
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