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[Right coronary-ventricular fistula. Diagnosis and course. Apropos of 2 cases]
S Kammoun1, B Chaffai, M Marouene
1Service de Cardiologie, CHU Hedi Chaker, Tunisie.
Insights
Two cases of coronary-right ventricular fistulas were diagnosed in pediatric patients. Early surgical treatment is crucial to prevent complications like aneurysmal dilatation.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Coronary-right ventricular fistulas are rare congenital heart anomalies.
- Diagnosis is often incidental, discovered during evaluation for heart murmurs.
Observation:
- Two pediatric cases presented with incidental findings of coronary-right ventricular fistulas.
- The left anterior descending artery was implicated in both cases, with the right ventricle as the recipient cavity.
Findings:
- Doppler ultrasonography and coronary angiography confirmed the diagnosis.
- One patient was successfully treated with early surgical ligation.
- The other patient developed aneurysmal dilatation of the coronary artery.
Implications:
- Color Doppler ultrasound is valuable for noninvasive diagnosis, particularly in identifying the recipient cavity.
- Prompt surgical intervention for coronary fistulas is essential to prevent long-term complications.
- Delayed treatment can lead to serious sequelae, as evidenced by the aneurysmal dilatation.
Abstract:
The authors report two cases of coronary-right ventricular fistulas diagnosed in a 7-month-old infant and a 9-year-old girl. The discovery of the heart disease was incidental in both cases, following detection of a low continuous murmur. Doppler ultrasonography established the diagnosis, which was confirmed by haemodynamic studies and coronary angiography. The left anterior descending artery was involved in both cases and the recipient cavity was the right ventricle. The first patient was cured by early operation with distal ligation of the artery. In the second patient, the natural course was complicated by aneurysmal dilatation of the coronary artery. The authors recall the value of colour Doppler ultrasound in the noninvasive diagnosis, especially of the recipient cavity by colour Doppler and the need to rapidly treat coronary fistulas to prevent the development of complications reported after an average age of 20 years.