RESUMO
Coronary artery lesions related to pacemaker implantation are rare complications. With the increasing adoption of the technique of permanent transseptal pacing of the left bundle branch area pacing (LBBAP), an increase in the incidence of these complications may be expected. We report two cases of coronary lesions after permanent transeptal pacing of the LBBAP: the first with a small coronary artery fistula, and the second with an extrinsic coronary compression. Both complications occurred with stylet-driven pacing leads with extendable helix. In the first case, since the shunt volume was small and no major complications were reported, the patient was treated conservatively with good outcome. The second case required lead repositioning due to acute decompensated heart failure.
Assuntos
Insuficiência Cardíaca , Septo Interventricular , Humanos , Estimulação Cardíaca Artificial/efeitos adversos , Estimulação Cardíaca Artificial/métodos , Vasos Coronários , Eletrocardiografia/métodos , Sistema de Condução Cardíaco , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/prevenção & controle , Fascículo Atrioventricular , Resultado do TratamentoRESUMO
Abstract A 53-year-old man with an asymptomatic fistula from the Vieussens ring to the pulmonary artery presented with progressive respiratory distress. Coil embolization of this type of fistula has been described by femoral access. The advanced transradial "grandmother-mother-son" technique for high active support safely allows successful embolization of this type of coronary fistulae.
Resumen Un hombre de 53 años con una fístula asintomática del anillo de Vieussens a la arteria pulmonar comenzó con dificultad respiratoria progresiva. La embolización con coils de este tipo de fístulas ha sido descrita por acceso femoral. La técnica transradial avanzada "abuela-madre-hijo" para un alto soporte activo permite de manera segura la embolización exitosa de este tipo fístulas coronarias.
RESUMO
A 53-year-old man with an asymptomatic fistula from the Vieussens ring to the pulmonary artery presented with progressive respiratory distress. Coil embolization of this type of fistula has been described by femoral access. The advanced transradial "grandmother-mother-son" technique for high active support safely allows successful embolization of this type of coronary fistulae.
Un hombre de 53 años con una fístula asintomática del anillo de Vieussens a la arteria pulmonar comenzó con dificultad respiratoria progresiva. La embolización con coils de este tipo de fístulas ha sido descrita por acceso femoral. La técnica transradial avanzada "abuela-madre-hijo" para un alto soporte activo permite de manera segura la embolización exitosa de este tipo fístulas coronarias.
Assuntos
Anomalias dos Vasos Coronários , Fístula , Avós , Masculino , Humanos , Pessoa de Meia-Idade , Artéria Pulmonar , Angiografia Coronária/métodos , Relações Mãe-FilhoAssuntos
Fístula Artério-Arterial , Aneurisma Coronário , Doença da Artéria Coronariana , Fístula , Cardiopatias Congênitas , Fístula Vascular , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/cirurgia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Humanos , Artéria Pulmonar , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/cirurgiaRESUMO
We present the extremely rare case of a circumflex artery aneurysm with an arteriovenous fistula to the coronary venous sinus in a 20-year-old male patient, requiring surgical management due to the clinical presentation of this unusual condition.
RESUMO
BACKGROUND: Coronary artery aneurysms (CAAs) are uncommon, and giant aneurysms (>2 cm) are even more unusual. Coronary atherosclerosis and Kawasaki disease are the leading causes for this pathology. The treatment for this condition is controversial because the evidence is based on case report series. CASE SUMMARY: We describe the case of a 77-year-old female patient who presented with heart failure symptoms. She was diagnosed with a giant saccular aneurysm arising from the right coronary artery (RCA) ostium and a fistula between the RC and the left anterior descending artery (LAD) to the coronary sinus. And an atrial septal defect (ASD) and severe tricuspid regurgitation were also found. The patient underwent surgery through a medium sternotomy, the aneurysm was opened and resected under cardiopulmonary bypass. The RCA was ligated at the distal end of the aneurysm, and a saphenous vein graft bypass was performed. A coronary arteriovenous fistula from the distal portion of RC and LAD artery to a severely enlarged coronary sinus was found and corrected with an autologous pericardial patch. Closure of the ASD was performed with a pericardial patch and a tricuspid ring annuloplasty was done. Post-operative course was uneventful. DISCUSSION: There are few cases of giant coronary aneurysms associated with fistulas reported in the literature. Despite the endovascular percutaneous techniques available to treat these patients, we believe that surgical treatment was the best option for this particular case. We consider that surgical treatment is a very good option for giant CAAs associated with AV fistulas that are not susceptible for current endovascular available devices. The literature lacks evidence regarding the best approach for these cases, and we think that invasive treatment should be tailored according to the heart's anatomy and patient risk.
RESUMO
RESUMEN La ateroesclerosis es una enfermedad sistémica que afecta múltiples lechos vasculares. Después de períodos prolongados de progresión comienzan las manifestaciones clínicas, de forma aguda o crónica (infarto agudo de miocardio, angina estable, claudicación intermitente, enfermedad cerebrovascular, entre otras); por lo que puede cursar de manera subclínica en pacientes con enfermedad arterial coronaria. Lo interesante de esta forma de presentación es que dentro de una serie de casos con enfermedad multivaso, asociado a un índice tobillo-brazo (ITB) < 0,9, después de un síndrome coronario agudo, hemos encontrado, como hallazgo angiográfico, la presencia de una fístula coronaria a ventrículo derecho en un paciente con ITB muy bajo y clínica de claudicación intermitente. Esta fístula es la causa de los síntomas que interrumpieron la rehabilitación cardiovascular; es una enfermedad poco frecuente y causa de dolor torácico, que se informa solo de 0,3 a 0,8%, como hallazgo incidental en angiografías coronarias.
ABSTRACT Atherosclerosis is a systemic disease that affects a number of vascular beds. Clinical manifestations whether acute or chronic (acute myocardial infarction, stable angina, intermittent claudication, cerebrovascular disease, among others) start after long periods of progression; so it may present subclinically in patients with coronary artery disease. What is particularly interesting about this form of presentation is that within a series of cases with multivessel disease, associated with an ankle-brachial index (ABI)<0.9, after an acute coronary syndrome, we have identified, as an angiographic finding, the presence of a coronary artery fistula to the right ventricle in a patient with very low ABI and clinical intermittent claudication. This fistula led to the symptoms that hampered cardiovascular rehabilitation. It is an infrequent disease characterized by chest pain; with low reporting (0.3 to 0.8%), as an incidental finding in coronary angiographies.
Assuntos
Reabilitação , Fístula Artério-Arterial , Angiografia Coronária , Índice Tornozelo-Braço , Doença Arterial Periférica , IsquemiaRESUMO
Coronary artery fistulas are rare clinical entities and their association with giant coronary aneurysms is even more unusual. Most fistulas are asymptomatic, but aneurysms could develop symptoms depending on their diameter. We present a patient with chest pain and cardiac arrest, who later developed cardiac tamponade that needed emergency surgery, due to rupture of a giant coronary aneurysm developed from confluent coronary artery fistulas from two coronary arteries to pulmonary artery.
RESUMO
Resumen: La fístula coronaria es una anomalía caracterizada por una comunicación anormal entre una arteria coronaria y una cámara cardíaca o un gran vaso. El 50% de las fístulas se originan de la arteria coronaria derecha, 45% de la arteria coronaria izquierda y menos del 5% en ambas. Se presenta una paciente femenina de 81 años de edad con historia de ataque cerebrovascular isquémico de forma previa, quien ingresa con nuevo evento isquémico cerebral. En estudios complementarios se documentó una fracción de eyección del ventrículo izquierdo reducida por lo que se realizó arteriografía con hallazgo de arterias coronarias epicárdicas sin enfermedad obstructiva significativa, pero con fístula coronario-pulmonar en segmento medio de arteria descendente anterior y una fístula coronario-pulmonar en segmento proximal de la arteria coronaria derecha. Las fístulas coronarias son una entidad rara, con síntomas inespecíficos. La mayoría de las veces se diagnostica de forma incidental al realizar una arteriografía coronaria por otro motivo. El manejo varía de acuerdo a las manifestaciones y anatomía encontrada junto con la experiencia del equipo de cardiología.
Abstract: Coronary fistula is an abnormality characterized by abnormal communication between a coronary artery and a cardiac chamber or large vessel. Half of fistulas originate from the right coronary artery, 45% from the left coronary artery, and less than 5% originate from both. We present an 81-year-old female patient with a history of previous ischemic stroke, who was admitted with a new cerebral ischemic event. In complementary studies, a reduced ejection fraction of the left ventricle was documented, then arteriography was performed showing epicardial coronary arteries without significant obstructive disease, but with coronary-pulmonary fistula in the middle segment of the anterior descending artery and a coronary-pulmonary fistula in the proximal segment of the right coronary artery. Coronary fistulas are a rare entity, with nonspecific symptoms. Most of the time this entity is diagnosed incidentally when performing a coronary arteriography for another reason. Management varies according to the manifestations and anatomy found along with the experience of the cardiology team.
Resumo: A fístula coronária é uma anormalidade caracterizada pela comunicação anormal entre uma artéria coronária e uma câmara cardíaca ou um vaso grande. Metade das fístulas são originárias da artéria coronária direita, 45% da artéria coronária esquerda e menos de 5% são originárias de ambas. Se você apresentar um paciente feminino de 81 anos de idade com história de ataque cerebrovascular isquêmico de forma prévia, que ingressou com o novo evento isquêmico cerebral. Em estudos complementares, documentou-se uma fração de ejeção reduzida do ventrículo esquerdo e, em seguida, foi realizada arteriografia mostrando artérias coronárias epicárdicas sem doença obstrutiva, mas com uma fístula coronário-pulmonar no segmento médio da artéria descendente anterior e uma fístula coronário-pulmonar no segmento proximal da artéria artéria coronária direita. As fístulas coronárias são uma entidade rara, com sintomas inespecíficos. Na maioria das vezes, essa entidade é diagnosticada incidentalmente ao realizar uma arteriografia coronariana por outro motivo. O manejo varia de acordo com as manifestações e anatomia encontradas, juntamente com a experiência da equipe de cardiologia.
RESUMO
Aortic dissection and rupture occur in 20-40% of patients with Marfan's syndrome. This occurs predominantly in the third and fourth decade of life, contributing to the increased morbidity and mortality of this specific group of patients. This is the first known documented case report of pre-pubertal left coronary sinus rupture with left coronary artery aneurysms with fistulous communication to both the superior vena cava and right superior pulmonary vein, presenting with a continuous murmur.
La disección y ruptura aórticas ocurren en 20-40% de los pacientes con el síndrome de Marfan. Esto ocurre predominantemente en la tercera y cuarta décadas de la vida, contribuyendo al aumento de la morbilidad y la mortalidad de este grupo específico de pacientes. Éste es el primer reporte de un caso documentado conocido de ruptura prepubertal del seno coronario izquierdo con aneurisma de la arteria coronaria izquierda, y comunicación fistulosa tanto con la vena cava superior como con la vena pulmonar superior derecha, acompañada de un soplo continuo.
Assuntos
Adolescente , Criança , Feminino , Humanos , Gravidez , Aneurisma/diagnóstico , Ruptura Aórtica/diagnóstico , Fístula Arteriovenosa/diagnóstico , Aneurisma Coronário/diagnóstico , Doença da Artéria Coronariana/diagnóstico , Síndrome de Marfan/diagnóstico , Complicações Cardiovasculares na Gravidez/diagnóstico , Veias Pulmonares , Seio Aórtico , Veia Cava Superior , Aborto Induzido , Angiografia Coronária , Ecocardiografia , Seguimentos , Interpretação de Imagem Assistida por Computador , Imageamento Tridimensional , Jamaica , Tomografia Computadorizada MultidetectoresRESUMO
Coronary artery fistulas are unusual congenital or acquired coronary artery abnormalities in which blood is shunted into a cardiac chamber, great vessel or other structure, bypassing the myocardial capillary network (Jung et al. in Cardiovasc Ultrasound 5:10, 2007). We present a young adult patient with an asymptomatic fistula from a giant aneurysmatic left anterior descending artery to the right ventricular outflow tract, first diagnosed by echocardiography examination and further confirmed by 128-slice computed tomography coronary angiography.