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Coronary neovascularity and fistula formation: a sign of mural thrombus

R L Soulen, J H Grollman, D Paglia

    Circulation
    |October 1, 1977
    PubMed

    Insights

    Neovascularity in the left heart, often linked to cardiac thrombi, was observed in patients. Angiography revealed fistulous communications, differentiating these findings from cardiac myxomas.

    Area of Science:

    • Cardiovascular Imaging
    • Interventional Cardiology
    • Pathology

    Background:

    • Neovascularity within the left heart is an uncommon finding.
    • Its association with cardiac thrombi and aneurysms requires further investigation.
    • Differentiating neovascularity from cardiac tumors like myxomas is clinically significant.

    Purpose of the Study:

    • To describe the angiographic and histologic features of left heart neovascularity.
    • To investigate the association of neovascularity with mural thrombi and cardiac abnormalities.
    • To differentiate neovascularity from cardiac myxomas.

    Main Methods:

    • Selective coronary arteriography in fifteen patients.
    • Histologic examination of atrial thrombi.
    • Clinical and angiographic feature analysis.

    Main Results:

    • Neovascularity with fistulous communication to cardiac chambers observed in ten patients.
    • Abnormalities adjacent to ventricular mural thrombi in nine patients, associated with aneurysms or cardiomyopathy.
    • Angiographic changes related to left atrial thrombi in six patients with mitral stenosis and atrial fibrillation.
    • Histology confirmed revascularization patterns in mural thrombi.

    Conclusions:

    • Left heart neovascularity can be associated with mural thrombi and cardiac chamber abnormalities.
    • Angiographic and clinical features aid in differentiating neovascularity from cardiac myxomas.
    • Histologic findings support an intermediate stage in mural thrombus evolution.

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