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[Coronary-left ventricular fistulae]
Insights
This case report details rare coronary-left ventricular fistulae diagnosed via angiography. The condition caused unstable angina due to a coronary steal syndrome, potentially treatable with surgery in select cases.
Area of Science:
- Cardiology
- Vascular Surgery
- Diagnostic Imaging
Background:
- Coronary artery fistulae are rare abnormal connections between coronary arteries and heart chambers.
- Unstable angina can be a symptom of complex coronary artery anomalies.
- Early and accurate diagnosis is crucial for appropriate patient management.
Observation:
- A 58-year-old man presented with new-onset unstable angina without myocardial infarction.
- Coronary angiography revealed multiple fistulous communications between septal arteries, left diagonal branches, the right coronary artery, and the left ventricle apex.
- Ascending aortography confirmed the diagnosis of coronary-left ventricular fistulae.
Findings:
- The coronary circulation showed dilatation and rapid emptying, indicative of increased flow from the shunt.
- No coronary artery stenosis or ectasia was observed.
- The case highlights the rarity of fistulae involving both major coronary arteries and the left ventricle.
Implications:
- Coronary-left ventricular fistulae can cause angina through a coronary steal phenomenon.
- Angiography is the gold standard for diagnosing these fistulae.
- Surgical intervention may be considered for cases with high flow and favorable anatomy.
Abstract:
The authors report a case of fistulae between the right and left coronary arteries and the left ventricle. A 58 year old man was investigated for inaugural unstable angina without infarction. Coronary angiography showed multiple communications between the terminal branches of the septal arteries of the left anterior descending, the terminal segments of the left diagonal and the terminal portion of the right coronary artery and the apical region of the left ventricle. Angiography in the ascending aorta confirmed the diagnosis of coronary-left ventricular fistulae. The dilatation and rapid emptying of the entire coronary circulation were indirect signs of increased flow due to the shunt. There was no coronary alternation or stenosis. The rarity of coronaro-cardiac fistulae, especially involving both main coronary arteries and the left ventricle, is emphasised. The symptoms of angina are explained by the coronary "steal" syndrome : the diagnosis is angiographic; rare cases with high flow and a favourable anatomical set up may be managed surgically.