Coronary artery fistulas presenting with bacterial endocarditis

Alkhulaifi, Abdul M.; Horner, S M; Pugsley, W; Swanton, R. H.

doi:10.1016/s0003-4975(95)00037-2

Cited by 44 publications

(18 citation statements)

References 5 publications

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“…A case of paradoxical exacerbation of myocardial ischaemia with nitrates increasing the ‘steal’ is reported 7. People may present with ischaemic ECG changes,4 8 positive troponin4 and even bacterial endocarditis 9. These malformations were also reported in a carrier of fragile X syndrome 10…”

Section: Descriptionmentioning

confidence: 84%

A significant ‘coronary steal’ by thebesian veins, a rare congenital coronary defect masquerading as acute coronary syndrome

2015

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DESCRIPTIONA 72-years-old woman presented with intermittent chest pains, anterolateral T-wave inversions on ECG and troponin-T of 6290 ng/L. Acute coronary syndrome treatment was initiated. The coronary angiography demonstrated tortuous calcified coronaries without any significant obstructive lesion. However, late dye acquisition images revealed a capillary blush originating from the diagonal branch of left anterior descending artery (figures 1 and 2) and the distal right coronary artery (figures 3 and 4) feeding into the ventricular cavity through intramural thebesian vein connections, almost producing a ventriculogram (figures 5 and 6).This episode which otherwise would been an undetectable plaque event, turned out to be one of significant myocardial injury due to background presence of the 'the coronary steal' syndrome.Persistence of embryonic coronary artery fistulas in form of diffuse vascular network directly draining oxygenated blood from the coronaries into the ventricles bypassing the myocardial capillary network are called thebesian veins. Coronary artery fistulas are rare (<0.2% 1 ), remain silent and often discovered incidentally on coronary angiogram or ventriculography.2 They rarely become haemodynamically significant and become a nonatherosclerotic cause of angina via the coronary steal phenomenon. 3Case reports of steal Figure 1 The flow through the coronary artery fistula (thebesian veins) in the diagonal branch of left anterior descending artery is seen (in late dye acquisition images) as a capillary blush (marked with arrows) in the RAO cranial view. This flow is causing drainage of oxygenated blood directly from coronaries into the ventricular cavity. Figure 2 The flow through the coronary artery fistula (thebesian veins) in the diagonal branch of left anterior descending artery is seen (in late dye acquisition images) as a capillary blush (marked with arrows) in the RAO caudal view. This flow is causing drainage of oxygenated blood directly from coronaries into the ventricular cavity. Figure 3 The flow through the coronary artery fistula (thebesian veins) in the distal right coronary artery is seen (in late dye acquisition images) as a capillary blush (marked with arrows) in the LAO view. This flow is causing drainage of oxygenated blood directly from coronaries into the ventricular cavity.

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Section: Descriptionmentioning

confidence: 84%

A significant ‘coronary steal’ by thebesian veins, a rare congenital coronary defect masquerading as acute coronary syndrome

2015

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“…After this, the frequency of both symptoms and complications increases [7]. Complications include 'steal' from the adjacent myocardium causing myocardial ischaemia, thrombosis and embolism, cardiac failure, atrial fibrillation, rupture, endocarditis/endarteritis and arrhythmias [1,4,8,9]. Thrombosis within the fistula is rare but may cause acute myocardial infarction, and atrial and ventricular arrhythmias [10].…”

Section: Clinical Featuresmentioning

confidence: 99%

Coronary arterial fistulas

Qureshi

2006

Orphanet J Rare Dis

182

157

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“…However, because of recurrent chest pain and the presence of dyspnea and to prevent possible long-term complications such as bacterial endocarditis, heart failure, myocardial infarction, or rupture of aneurysmal fistula [3,6,10,11], the patient underwent surgical ligation of both coronary fistulas using extracorporeal circulation. Intraoperatively, a large tortuous vessel was found coursing from the area of the right coronary artery across the base of the pulmonary artery (Fig.…”

Section: Case Historymentioning

confidence: 99%