Multivessel Coronary Artery Disease in a Patient With Noncompaction Cardiomyopathy With Coronary Artery-to-Left
Do Van Chien1, Pham The Tho1, Pham Son Lam1
1Department of Cardiology, 108 Central Military Hospital, Hanoi, Vietnam.
JACC. Case Reports
|May 2, 2022
Insights
The rare coexistence of coronary artery-to-left ventricle fistula and noncompaction cardiomyopathy presents unique challenges. Total revascularization may not improve left ventricular ejection fraction in these complex cardiac cases.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardiovascular Imaging
Background:
- Coronary artery-to-left ventricle fistula (CALVF) and noncompaction cardiomyopathy (NCC) are uncommon conditions.
- Their coexistence, particularly with severe coronary stenosis, is exceptionally rare.
- Acute coronary syndrome (ACS) further complicates the clinical presentation.
Observation:
- A 70-year-old male patient presented with acute coronary syndrome.
- The patient was diagnosed with both noncompaction cardiomyopathy and coronary artery-to-left ventricle fistula.
- Severe multiple coronary stenosis was also noted.
Findings:
- The case highlights the diagnostic and therapeutic challenges posed by the simultaneous presence of CALVF and NCC.
- Left ventricular ejection fraction (LVEF) response to interventions was evaluated.
- Findings suggest that LVEF may not significantly improve even after complete revascularization in such complex scenarios.
Implications:
- This case underscores the importance of considering rare cardiac anomalies in patients with complex coronary artery disease.
- It suggests limitations of standard revascularization strategies in improving systolic function in the presence of combined CALVF and NCC.
- Further research into tailored treatment approaches for this specific patient population is warranted.
Abstract:
Coexistence of coronary artery-to-left ventricle fistula (CALVF) and noncompaction cardiomyopathy (NCC) is rare in patients with severe multiple coronary stenosis. We report CALVF in a 70-year-old man with acute coronary syndrome (ACS) and NCC. Left ventricular ejection fraction may not improve by total revascularization in this condition. (Level of Difficulty: Advanced.).
Keywords:
ACS, acute coronary syndromeCAF, coronary artery fistulaCALVF, coronary artery-to-left ventricle fistulaCTO, chronic total occlusionLAD, left artery descending arteryLV, left ventricleNCC, noncompaction cardiomyopathyPCI, percutaneous coronary interventionRCA, right coronary arteryacute coronary syndromecoronary artery-to-left ventricle fistulamultiple coronary stenosispercutaneous coronary interventionrevascularization
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