Apical hypertrophic cardiomyopathy associated with multiple coronary artery–left ventricular fistulae: a report of a case and review of the literature

Abstract

We present a rare case of multiple coronary artery-left ventricular (LV) fistulae, associated with apical hypertrophic cardiomyopathy in an 83-year-old woman with electrocardiographic abnormalities and a history of arterial hypertension and paroxysmal atrial fibrillation. In order to evaluate the clinical significance and obtain further insights into this unusual disease, the patient has undergone coronary angiography, left ventriculography, and magnetic resonance imaging which better substantiated the structural abnormalities of the LV and the coronary network.

Apical Hypertrophic Cardiomyopathy And Multiple Coronary Artery-left Ventricular Fistulas: A Case Report.

“…Furthermore, transthoracic echocardiography could be a good basic technique able to outline both apical hypertrophic cardiomyopathy and fistula, as our case report showed [6]. Stress echocardiography could evaluate hemodynamic value of fistula and surely contrast echocardiography would not add anything else to the final diagnosis [6].…”

“…At the best of our knowledge, about ten of these cases had been described and all were symptomatic and associated with classical forms apical hypertrophic cardiomyopathy [3][4][5][6]. Our patients, instead, originally showed a tight regional relationship between hypertrophic regions and fistula drainage sites.…”

“…In 20% of cases, they are associated with other heart congenital abnormalities characterized by obstacles to the efflux. In 90% of cases, their drainage went to right cardiac section; in 40 The association between apical hypertrophic cardiomyopathy and coronary fistula is very rare [3][4][5][6].…”

“…Stress echocardiography could evaluate hemodynamic value of fistula and surely contrast echocardiography would not add anything else to the final diagnosis [6].…”

“…Only multislices computer tomography is considered as gold standard technique in congenital coronary abnormalities evaluation [1,6].…”