Assessment of patients with multiple coronary ventricular fistulas
Keywords:
ANOMALIES OF THE CORONARY VESSELS, ARTERIOVENOUS FISTULA, ANGINA PECTORIS
Abstract
We describe four women with angina pectoris and positive functional tests using cineangiocoronarygraphy, multiple coronary ventricular fistulas were found but no obstructive injuries were seen. Stress testing by bicycle ergometer was assessed by a modificated Bruce protocol. Three cases underwent a MIBI myocardial scintigraphy with progressive exercise test and the remainder underwent dipyridamole-thalium imaging. Multiple coronary ventricular fistulas is an alteration of coronary circulation that includes an abnormal communication between coronary arteries and a cardiac camera characterized by multiple fistulas of small caliber. They are also known as generalized myocardial microfistulas. Estimated prevalence is lower than 0.2%. Angina is the main symptom, coronary steal is supposed to be the physiopathologic mechanism, but cases with recorded ischemia are rare. We agree with the description appeared in international literature of patients with angor, positive functional tests and no obstructive coronary injuries, where multiple coronary ventricular fistulas are indicated as causing this symptomatology.
References
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19) Kourouclis C, Viskos D, Papadopoulos P, Augoustakis D. Multiple coronary arteriovenous fistulae. Acta Cardiol 1976; 31(4): 333-8.
20) Brasileiro AL, Bondarovsky S, Pessanha A, Leandro S, Nascimento CA. Multiple Coronary Artery to Left Ventricle Fistulae. Arq Bras Cardiol 1997; 68(4): 281-4.
21) Liu YC, Lin SJ, Ding PY, Chang MS. Diffuse multiple coronary arteries to left ventricular fistulas. Zhonghua Yi Xue Za Zhi (Taipei) 2000; 63(7): 573-6.
22) Russo G, Di Paola R, Tamburino C, Greco G, Calvi V, Monaco A, Giuffrida G. Multiple coronary-pulmonary fistulas: description of a case. Cardiologia 1990; 35(10): 863-5.
23) Gonda RL, Gutiérrez OH, Moss AJ, Lee HJ. Multiple coronary artery-left ventricular fistulas: a pattern of anomalous coronary microvascularization. Cardiovasc Intervent Radiol 1988; 11(6): 313-8.
24) Lipoff JI. Multiple spontaneously occurring coronary artery-left ventricular communications: a case report. J Ky Med Assoc 1999; 97(5): 208-10.
25) Herschman A, Natarajan N, Reddy K. Multiple fistulas between the coronary arteries and the left ventricle. Radiology 1977; 122(2): 302.
26) Jacob MA, Goyal SB, Pacifico L, Spodick DH. Multiple coronary artery-left ventricular fistulas associated with hereditary hemorrhagic telangiectasia. Chest 2001; 120(4): 1415-7.
27) Carini G, Dalmasso M, Orzan F. Small fistulas between circumflex coronary artery and left atrium associated with rheumatic valvular cardiomyopathy. A case report (author's transl). G Ital Cardiol 1980; 10(8): 1085-8.
28) Delarche N, Colle JP. Multiple left coronary-ventricular microfistula and apical hypertrophy. Arch Mal Coeur Vaiss 1993; 86(1): 75-8.
29) Dewhurst NG, Colledge NR, Miller HC. Severe pulmonary hypertension and multiple left coronary arterial fistulas in association with congenital hepatic fibrosis. Br Heart J 1987; 58(5): 525-7.
30) Endo T, Koumi S, Katsuta Y, Hayakawa H, Okumura H. Multiple coronary arteriovenous fistulas associated with polymyositis. Cardiology 1990; 77(1): 58-61.
31) Monmeneu JV, Bodí V, Sanchís J, Chorro FJ, Llopis R, Insa L, et al. Miocardiopatía hipertrófica apical y múltiples fístulas entre coronarias y ventrículo izquierdo. Rev Esp Cardiol 1995; 48(11): 768-70.
2) Pelech AN. Coronary cameral fistula. Medicine J 2001: 2(6). Disponible en: www.emedicine.com (visto 20/12/2002).
3) Robbins C. Vasos sanguíneos. In: Patología estructural y funcional 4 ed. Interamericana. Madrid: McGraw-Hill, 1990: 587-631. v.1.
4) Piovaccari G, Melandri G, Marzocchi A, Scarfoglio D, Sanguinetti M, Magnani B. Multiple coronary fistulas to the left ventricle. An unusual cause of myocardial ischemia. Cardiologia 1989; 34(4): 375-7.
5) Schwartz L, Bourassa MG. Evaluation of patients with chest pain and normal coronary angiograms. Arch Intern Med 2001; 161(15): 1825-33.
6) Gascuena Rubia R, Hernández Hernández F, Tascon Pérez JC, Albarran González-Trevilla A, Lázaro Salvador M, Hernández Simon P. Demonstrated myocardial ischemia due to multiple coronary fistulae draining into the left ventricle. Rev Esp Cardiol 2000; 53(5): 748-51.
7) Vavuranakis M, Bush CA, Boudoulas H. Coronary artery fistulas in adults: incidence, angiographic characteristics, natural history. Cathet Cardiovasc Diagn 1995; 35(2): 116-20.
8) Liberthson RR, Sagar K, Berkoben JP, Weintraub RM, Levine FH. Congenital coronary arteriovenous fistula. Report of 13 patients, review of the literature and delineation of management. Circulation 1979; 59(5): 849-54.
9) Ropers D, Moshage W, Daniel WG, Jessl J, Gottwik M, Achenbach S. Visualization of coronary artery anomalies and their anatomic course by contrast-enhanced electron beam tomography and three-dimensional reconstruction. Am J Cardiol 2001; 87(2): 193-7.
10) Liu PR, Leong KH, Lee PC, Chen YT. Congenital coronary artery-cardiac chamber fistulae: a study of fourteen cases. Zhonghua Yi Xue Za Zhi (Taipei) 1994; 54(3): 160-5.
11) Ahmed SS, Haider B, Regan TJ. Silent left coronary artery-cameral fistula: probable cause of myocardial ischemia. Am Heart J 1982; 104: 869-70.
12) Rubini G, Ettorre GC, Sebastiani M, Bovenzi F. Evaluation of hemodynamic significance of arteriovenous coronary fistulas: diagnostic integration of coronary angiography and stress/rest myocardial scintigraphy. Radiol Med (Torino) 2000; 100(6): 453-8.
13) Kiuchi K, Nejima J, Kikuchi A, Takayama M, Takano T, Hayakawa H. Left coronary artery-left ventricular fistula with acute myocardial infarction, representing the coronary steal phenomenon: a case report. J Cardiol 1999; 34(5): 279-84.
14) Said SA, van der Werf T. Acquired coronary cameral fistulas: are these collaterals losing their destination? Clin Cardiol 1999; 22(4): 297-302.
15) Sherwood MC, Rockenmacher S, Colan SD, Geva T. Prognostic significance of clinically silent coronary artery fistulas. Am J Cardiol 1999; 83(3): 407-11.
16) Stierle U, Giannitsis E, Sheikhzadeh A, Potratz J. Myocardial ischemia in generalized coronary artery-left ventricular microfistulae. Int J Cardiol 1998; 63(1): 47-52.
17) Coussement P, De Geest H. Multiple coronary artery-left ventricular communications: an unusual prominent Thebesian system. A report of four cases and review of the literature. Acta Cardiol 1994; 49(2): 165-73
18) Black IW, Loo CK, Allan RM. Multiple coronary artery-left ventricular fistulae: clinical, angiographic, and pathologic findings. Cathet Cardiovasc Diagn 1991; 23(2): 133-5.
19) Kourouclis C, Viskos D, Papadopoulos P, Augoustakis D. Multiple coronary arteriovenous fistulae. Acta Cardiol 1976; 31(4): 333-8.
20) Brasileiro AL, Bondarovsky S, Pessanha A, Leandro S, Nascimento CA. Multiple Coronary Artery to Left Ventricle Fistulae. Arq Bras Cardiol 1997; 68(4): 281-4.
21) Liu YC, Lin SJ, Ding PY, Chang MS. Diffuse multiple coronary arteries to left ventricular fistulas. Zhonghua Yi Xue Za Zhi (Taipei) 2000; 63(7): 573-6.
22) Russo G, Di Paola R, Tamburino C, Greco G, Calvi V, Monaco A, Giuffrida G. Multiple coronary-pulmonary fistulas: description of a case. Cardiologia 1990; 35(10): 863-5.
23) Gonda RL, Gutiérrez OH, Moss AJ, Lee HJ. Multiple coronary artery-left ventricular fistulas: a pattern of anomalous coronary microvascularization. Cardiovasc Intervent Radiol 1988; 11(6): 313-8.
24) Lipoff JI. Multiple spontaneously occurring coronary artery-left ventricular communications: a case report. J Ky Med Assoc 1999; 97(5): 208-10.
25) Herschman A, Natarajan N, Reddy K. Multiple fistulas between the coronary arteries and the left ventricle. Radiology 1977; 122(2): 302.
26) Jacob MA, Goyal SB, Pacifico L, Spodick DH. Multiple coronary artery-left ventricular fistulas associated with hereditary hemorrhagic telangiectasia. Chest 2001; 120(4): 1415-7.
27) Carini G, Dalmasso M, Orzan F. Small fistulas between circumflex coronary artery and left atrium associated with rheumatic valvular cardiomyopathy. A case report (author's transl). G Ital Cardiol 1980; 10(8): 1085-8.
28) Delarche N, Colle JP. Multiple left coronary-ventricular microfistula and apical hypertrophy. Arch Mal Coeur Vaiss 1993; 86(1): 75-8.
29) Dewhurst NG, Colledge NR, Miller HC. Severe pulmonary hypertension and multiple left coronary arterial fistulas in association with congenital hepatic fibrosis. Br Heart J 1987; 58(5): 525-7.
30) Endo T, Koumi S, Katsuta Y, Hayakawa H, Okumura H. Multiple coronary arteriovenous fistulas associated with polymyositis. Cardiology 1990; 77(1): 58-61.
31) Monmeneu JV, Bodí V, Sanchís J, Chorro FJ, Llopis R, Insa L, et al. Miocardiopatía hipertrófica apical y múltiples fístulas entre coronarias y ventrículo izquierdo. Rev Esp Cardiol 1995; 48(11): 768-70.
Published
2003-12-31
How to Cite
1.
Durán A, Michelis V, Díaz P, Lujambio M, Kuster F, Lluberas R, Romero C. Assessment of patients with multiple coronary ventricular fistulas. Rev. Méd. Urug. [Internet]. 2003Dec.31 [cited 2024May16];19(3):237-41. Available from: http://www2.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/856
Section
Casuistry
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