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Asymptomatic continuous murmur due to acquired coronary artery to right ventricular fistula
Insights
An acquired coronary artery to right ventricle fistula developed after a chest puncture wound. This rare condition, a left anterior descending artery to right ventricle communication, was managed conservatively due to its small size.
Area of Science:
- Cardiology
- Cardiovascular Surgery
Background:
- Acquired coronary artery fistulas are rare cardiovascular conditions.
- Traumatic injuries to the chest can lead to coronary artery abnormalities.
Observation:
- A continuous murmur was detected one month post-puncture wound to the precordium.
- Cardiac catheterization revealed a left anterior descending coronary artery to right ventricle fistula.
- Angiography showed a false aneurysm of the left anterior descending artery with rupture into the right ventricle.
Findings:
- The fistula resulted in a small left-to-right shunt.
- The patient maintained normal cardiac pressures.
- No myocardial ischemia or infarction was observed during 36 months of follow-up.
Implications:
- Small, intracardiac coronary artery fistulas may be managed conservatively.
- This case highlights an unusual complication of traumatic cardiac injury.
- Long-term monitoring is essential for asymptomatic patients with coronary fistulas.
Abstract:
An unusual case of an acquired coronary artery to right ventricular fistula is reported. A new continuous murmur was noted one month following a puncture wound to the precordium. Cardiac catheterization documented a left anterior descending coronary artery to right ventricular communication with a small left to right shunt and normal cardiac pressures. The angiographic appearance was that of a false aneurysm of the anterior descending artery with rupture into the right ventricle. The patient has been followed for 36 months and is asymptomatic with no evidence of myocardial ischemia or infarction. Because of the small size of the fistula and its intracardiac position, conservative treatment has been employed.