A fistula between the circumflex artery and the coronary sinus mimicks coronary artery disease in a 63-year-old woman
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《血管的通路杂志》
1 Department of Cardiovascular Surgery, University of Freiburg, Freiburg i. Br., Germany
2 Department of Cardiology, University of Freiburg, Freiburg i. Br., Germany
Abstract
A 63-year-old woman presented with angina and shortness of breath (NYHA III). Selective coronary angiography revealed a gross AV-fistula between the circumflex artery and the coronary sinus. The patient underwent operative closure of the fistula and was discharged home without symptoms.
Key Words: Coronary anomaly; Coronary artery disease; Heart surgery
1. Case report
A 63-year-old woman presented with a short history of worsening angina and shortness of breath (NYHA III). She had been previously healthy and was only being treated for arterial hypertension. ECG was without pathological findings. Selective coronary angiography revealed a gross, aneurysmatic AV-fistula between the circumflex artery and the coronary sinus (Fig. 1a). Contractile function was normal (ejection fraction: 66%). Arterio-venous shunting was determined by additional Swan-Ganz catheterization and oximetry. The measurements revealed a left-to-right shunt of 0.55 (Qp:Qs=1.8:1). Cardiac Index was 3.6 l/min/m2. Fig. 2 shows the fistula in situ. The fistula was closed by incising the distal part of the aneurysm and sewing a pericardial patch over the opening of the fistula into the coronary sinus using cardiopulmonary bypass with cardioplegic arrest. The circumflex artery was not a suitable target for a bypass. Fig. 1b shows the coronary angiogram eight weeks after surgery in which there is no longer a connection between the circumflex artery to the coronary sinus. Postoperative course was uneventful. The patient was discharged home with a significant improvement of symptoms (NYHA I) eight days after the operation.(Wolfgang Bothe, Christian)
2 Department of Cardiology, University of Freiburg, Freiburg i. Br., Germany
Abstract
A 63-year-old woman presented with angina and shortness of breath (NYHA III). Selective coronary angiography revealed a gross AV-fistula between the circumflex artery and the coronary sinus. The patient underwent operative closure of the fistula and was discharged home without symptoms.
Key Words: Coronary anomaly; Coronary artery disease; Heart surgery
1. Case report
A 63-year-old woman presented with a short history of worsening angina and shortness of breath (NYHA III). She had been previously healthy and was only being treated for arterial hypertension. ECG was without pathological findings. Selective coronary angiography revealed a gross, aneurysmatic AV-fistula between the circumflex artery and the coronary sinus (Fig. 1a). Contractile function was normal (ejection fraction: 66%). Arterio-venous shunting was determined by additional Swan-Ganz catheterization and oximetry. The measurements revealed a left-to-right shunt of 0.55 (Qp:Qs=1.8:1). Cardiac Index was 3.6 l/min/m2. Fig. 2 shows the fistula in situ. The fistula was closed by incising the distal part of the aneurysm and sewing a pericardial patch over the opening of the fistula into the coronary sinus using cardiopulmonary bypass with cardioplegic arrest. The circumflex artery was not a suitable target for a bypass. Fig. 1b shows the coronary angiogram eight weeks after surgery in which there is no longer a connection between the circumflex artery to the coronary sinus. Postoperative course was uneventful. The patient was discharged home with a significant improvement of symptoms (NYHA I) eight days after the operation.(Wolfgang Bothe, Christian)