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Determination of shunt flow in a case of multiple arteriosystemic connections
Insights
This study reports a rare case of multiple coronary artery to systemic circulation connections in a patient with congestive heart failure. The condition was deemed an angiographic curiosity with no clear clinical significance.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Imaging
Background:
- Congestive heart failure (CHF) and atrial fibrillation are common cardiovascular conditions.
- Coronary artery anomalies can present with diverse clinical manifestations.
Observation:
- A 64-year-old woman presented with acute CHF and atrial fibrillation, responding well to medical treatment.
- Coronary angiography revealed multiple arteriovenous fistulas originating from both left and right coronary arteries.
- Coronary vessels and left ventricular function were noted to be normal, albeit tortuous.
Findings:
- Shunt flow magnitude and myocardial lactate extraction suggested the coronary vascular abnormality was an angiographic curiosity.
- The specific etiology of the patient's heart disease remained undetermined despite the identified anomaly.
Implications:
- Coronary artery fistulas, while rare, may not always correlate with significant clinical impact or explain underlying heart disease.
- Further investigation into the etiology of cardiovascular conditions is crucial, even in the presence of unusual angiographic findings.
Abstract:
A 64-year-old woman presented with acute congestive heart failure and atrial fibrillation, with good response to medical management. Selective coronary and left ventricular cineangiography demonstrated multiple arteriosystemic connections arising from both left and right coronary arteries, but normal (although tortuous) coronary vessels and ventricular contraction pattern. Determination of the magnitude of the shunt flow and concommitant measurement of myocardial lactate extraction suggested that this type of coronary vascular abnormality was an angiographic curiosity without discernible clinical import; however, the etiology of the patient's heart disease remains an enigma.