Abstract. The current study describes a case of right coronary artery fistula (CAF) misdiagnosed as right atrial myxoma (RAM). A 33-year-old man presented with a 13-year history of intermittent chest pain, and aggravation for 3 days. Echocardiography revealed an occupying lesion in the right atrium producing a partial dynamic tricuspid obstruction. The initial diagnosis was RAM, which causes partial right ventricular inflow tract obstruction. During cardiopulmonary bypass surgery, a giant mass was detected in the anterior wall of the right ventricle and an abnormal vascular fistula was observed at the bottom of the mass. Successful excision of the mass and closure of the fistula completely relieved the patient's presenting symptoms. The disease was subsequently diagnosed as right CAF draining to the myocardial void. The surgical management and misdiagnosis of the case are discussed herein. IntroductionCoronary artery fistulas (CAFs) are rare coronary anomalies in which abnormal connections exist between a coronary artery and a cardiac chamber or a major vessel (1,2). CAFs are present in 0.002% of the global population and comprise 48.7% of all congenital coronary anomalies. The fistula may be large (>250 mm) and tends to enlarge over time (3). According to the American College of Cardiology/American Heart Association guidelines (4), percutaneous or surgical closure is strongly recommended for the treatment of a large fistula. Atrial myxomas are the most prevalent type of primary heart tumor, and present with nonspecific symptoms of right heart failure, syncope, exertional dyspnea and pulmonary embolism (5,6). Cardiac myxomas most frequently arise in the left atrium (85%), and rarely in the right atrium (10%) or the ventricles (5%). Although this tumor is histologically benign, it should be classified as a potentially fatal tumor due to the potential for embolic complications, and the standard treatment for cardiac myxoma is surgical removal (7). The present report describes the case of a patient with right CAF draining to the myocardial void, which was misdiagnosed as right atrial myxoma (RAM). Case reportA 33-year-old man was admitted to The First Affiliated Hospital of Zhengzhou University for intermittent chest pain. The patient had a 13-year history of chest pain accompanied by a sense of impending doom following activity, which was relieved by rest. The duration, severity and frequency of the pain was aggravated 3 days prior to hospitalization.Upon physical examination, the patient's heart rate was regular at 50 bpm, blood pressure was 112/70 mmHg and body temperature was 36.8˚C. The lips and fingernails were neither cyanotic nor clubbed. No thrills were detected in the precordial region. Heart and lung sounds were normal, with no dry or moist rales and no arrhythmia or cardiac murmurs.All routine laboratory data were within normal limits. A chest X-ray (Multix Fusion; Siemens AG, Munich, Germany) indicated cardiomegaly, predominantly on the right side. In addition, electrocardiography (ECG; 6951E; Nihon Ko...
Objective:To document clinical experience of treating congenital heart disease combined with large patent ductus arteriosus with pulmonary artery closure in combination with patch technique.Methods:Thirty-six patients (8 males and 28 females) who suffered from congenital heart disease and underwent hybrid surgery in the First Affiliated Hospital of Zhengzhou University from October 2010 to February 2014 were selected for this study. They aged 14 to 39 years and weighed 32.20 to 61.50 kg. Diameter of arterial duct was between 10 mm and 13 mm; 28 cases were tube type, 4 cases were funnel type and four cases were window type. All patients had moderate or severe pulmonary arterial hypertension; besides, there were 28 cases of ventricular septal defect, 16 cases of atrial septal defect, eight cases of aortic insufficiency, four cases of mitral stenosis and insufficiency and four cases of infectious endocarditis. Cardz Pulmonary Bypass (CPB) was established after chest was opened along the middle line. With the help of Transesophageal echocardiography, large patent ductus arteriosus was blocked off through pulmonary artery. Pulmonary artery was cut apart after blocking of heart. Large patent ductus arteriosus on the side of pulmonary artery was strengthened with autologous pericardial patch.Results:Of 36 patients, 32 patients had patent ductus arteriosus closure device and four patients had atrial septal defect closure device. Pulmonary arteries of 36 cases were all successfully closed. Systolic pressure declined after closure ((54.86±19.23) mmHg vs (96.05±23.07) mmHg, p<0.05); average pulmonary arterial pressure also declined after closure ((39.15±14.83) mmHg vs (72.88±15.76) mmHg, p<0.05). The patients were followed up for one to fifty one months (average 11.5 months). Compared to before surgery, left atrial diameter, left ventricular diameter and pulmonary artery diameter all narrowed after surgery. Besides, clinical symptoms were relieved and cardiac function of the patients also improved.Conclusion:Hybrid surgery is feasible and safe in treating patients with large patent ductus arteriosus and congenital heart disease, which decreases surgical problems, shortens surgical time and lowers the incidence of complications.
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