Fístula da artéria coronária: relato de três casos operados e revisão da literatura

Abstract

Fístulas das artérias coronárias têm incidência baixa entre as cardiopatias congênitas, muitas vezes assintomáticas, devendo ser suspeitadas quando há presença de sopro contínuo no precórdio. Podem apresentar sintomas de precordialgia ou insuficiência cardíaca e devem ser estudadas adequadamente para tratamento seguro, tanto cirúrgico como por cateterismo ou acompanhamento clínico. No presente trabalho são relatados três casos tratados por operação com resultado satisfatório e a literatura é revisada.<br>Coronary arteries fistulas have low incidence on the congenital heart defects, many times they are assymptomatic, and have to be suspected when continuous cardiac murmur is present. The symptoms can be precordial pain or cardiac failure and they must be studied correctly to a save surgical management or clinic treatment. In this paper are related three cases surgically treated with good results and literature review

Fístula coronariana para ventrículo esquerdo: diagnóstico por tomografia computadorizada

“…The congenital origin is even more frequently seen than the acquired origin 2 and associated anomalies may occur. Associations with patent ductus arteriosus, tetralogy of Fallot, ventricular septal defect and acquired cardiopathies have already been described in the literature 5 . The acquired origins may be infectious, traumatic or iatrogenic…”

“…The "coronary flow withdrawal" phenomenon may also occur and, in such cases, the symptoms would be chest pain or signs of ischemia detected by the conventional electrocardiogram or during exercise testing, such as in the case observed. The ischemic event is not dependent on the size of the fistula and it has been described even with a small flow 5 .…”

“…Generally, drainage is carried out for low-pressure chambers 3 . Thus, the incidence of communication with right chambers is higher, between 39 and 41% for the right ventricle, between 26 and 33% for the right atrium, between 15 and 20% for the pulmonary artery, the coronary sinus and the superior vena cava 3,5 . Fistulas to the LV are very rare, with an incidence of only 3% 6,7 .…”

“…The diagnosis is usually made by echocardiography, especially when there is dilation of the coronary artery involved or high output coronary flow 5 , with cine-angiocardiography being the gold standard for diagnosis, revealing anatomical details that are important to the treatment The fistulas originated from the right coronary artery are more frequent (70%) and may also occur in the left coronary artery or in both arteries. Generally, drainage is carried out for low-pressure chambers 3 .…”

“…There is consensus that the surgical treatment should always be carried out, because we do not know exactly the natural progression of the disease, or the frequency of complications that may occur. The spontaneous closure of the fistula is very rare, but it has been described 5 . Some authors argue that endocarditis prophylaxis should be carried out in such individuals 4 .…”