Correção de fístula coronariana sem circulação extracorpórea: técnica da sutura única

Abstract

Correção de fístula coronariana sem circulação extracorpórea: técnica da sutura únicaOff-pump correction of coronary fistula: the single suture technique approach AbstractThe single suture technique was developed to obtain stabilization and exposure of all coronary branches during off-pump coronary artery bypass, while maintaining hemodynamic stability during the procedure. We describe the use of this technique during an off-pump correction of a coronary artery fistula associated with right coronary dilatation. The suggested technique is quicker and less complex than on-pump surgery. Furthermore, it can be a useful tool for congenital fistula correction in select cases, stimulating the practice of less invasive heart surgery in these patients.Descriptors: Cardiopulmonary Bypass. Arteriovenous Fistula. Coronary Artery Disease. Congenital Abnormalities. Heart Defects, Congenital. ResumoA técnica da sutura única foi desenvolvida para obter estabilização e exposição de todos os ramos coronarianos durante a cirurgia de revascularização do miocárdio, mantendo a estabilidade hemodinâmica durante o procedimento. Nós descrevemos a utilização desta técnica durante a correção de uma fístula arterial coronariana associada à dilatação coronariana direita, sem a utilização da circulação extracorpórea. A técnica sugerida é mais rápida e menos complexa do que a utilização do desvio cardiopulmonar. Além disso, essa técnica pode ser uma ferramenta útil para a correção de fístulas arteriais coronarianas em casos selecionados, permitindo a prática de abordagens menos invasivas nesses pacientes. Rev Bras Cir Cardiovasc 2009; 24(4): 581-583 the pericardium, in an equidistant position between the inferior vena cava and the left inferior pulmonary vein and, afterwards, trespassed by double cardiac tape. DescritoresThe operation table was moved to the Trendelemburg position and the two arms of the cardiac tape were tractioned downwards and sidewise, each arm on each side, as shown in Figure 1.

A Fistula between Coronary and Main Pulmonary Arteries with Chest Tightness

“…However, the coronary artery steal phenomenon may occur, causing myocardial ischemia of the segment perfused by the coronary artery distal to the CAF and dilation of the proximal artery to compensate for the flow. Symptomatic patients commonly present with heart failure secondary to volume overload resulting from left-to-right shunting, ischemia due to coronary steal, arrhythmia, fistula rupture or thrombosis, and infective endocarditis; in these cases, interventions are indicated [2]. Surgical treatment is previously the only option, but transcatheter interventions are emerging as alternatives in patients with suitable anatomy and/or without other complex cardiac lesions [3].…”

Coronary artery to pulmonary artery fistula

“…Drainage of the fistula into the pulmonary trunk has been reported in 17% of cases [3,5]. The operation is indicated when clinical symptom occur, such as cardiac insufficiency and myocardial ischemia, or the presence of a high flux fistula in an asymptomatic patient [6]. …”