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Coronary artery-left ventricular fistulae are rare congenital heart defects. This study reports four new cases, highlighting varied presentations and successful management strategies, including surgical ligation and medical treatment.
Area of Science:
- Cardiology
- Congenital Heart Disease
Background:
- Coronary artery-left ventricular fistulae are exceptionally rare cardiovascular anomalies.
- Only 19 cases have been previously documented in medical literature.
Observation:
- Four new cases of coronary artery-left ventricular fistulae are presented.
- Patients ranged from 5 to 43 years old, with varied clinical presentations including asymptomatic murmurs and angina pectoris.
- Diagnostic methods included hemodynamic studies, electrocardiography, treadmill stress tests, and selective coronary angiography.
Findings:
- One patient had an aneurysmally enlarged right coronary artery draining into the left ventricle, successfully treated with fistula ligation.
- Another patient with a similar right coronary artery fistula refused surgery and remained asymptomatic.
- A third patient presented with angina and multiple fistulae from all major coronary arteries to the left ventricle, managed medically with propranolol.
- The fourth patient, a child, had left coronary artery branches communicating with the left ventricle via fine vessels and remained well without intervention.
Implications:
- Coronary artery-left ventricular fistulae, though rare, require careful diagnosis and individualized management.
- Treatment strategies may include surgical intervention or medical management depending on fistula characteristics and patient condition.
- Further research into the long-term outcomes and optimal treatment of these rare fistulae is warranted.
Abstract:
Coronary artery-left ventricular fistulae are exceedingly rare and to date only 19 cases have been reported in the literature. We describe another four cases which we encountered recently. The first patient was a 10-year-old asymptomatic Indian male who was referred because of a to-and-fro murmur. Haemodynamic and angiographic studies revealed an aneurysmally enlarged right coronary draining into the left ventricle. The fistula was ligated and the patient has remained well over a 21/2-year follow-up period. The second patient was a 13-year-old asymptomatic Chinese female referred also because of a to-and-fro murmur. Haemodynamic and angiographic studies showed a grossly enlarged right coronary artery draining into the left ventricle. This patient refused operation and has remained well over a 2-year follow-up period. The third patient was a 43-year-old Chinese male who presented with a 3-year history of angina pectoris and was admitted to hospital because of crescendo angina. The resting electrocardiogram showed marked ischaemic changes and the treadmill exercise stress test was also positive. Selective coronary angiography showed markedly dilated right and left coronary arteries. Multiple fistulae from the three major coronary arteries were seen to communicate with the left ventricle. It was elected to treat this patient medically with propranolol. He has remained well over a 6-month follow-up period. The fourth patient was a 5-year-old asymptomatic Chinese girl. Cardiac catheterization and selective coronary angiography revealed marked dilatation of the branches of the left coronary artery which communicated via a maize of fine vessels into the left ventricle. This patient has remained well over a 5-year follow-up period. The clinical presentation, investigations and treatment of coronary artery-left ventricular fistula are discussed and the literature regarding this subject is reviewed.