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Spontaneous partial regression of coronary artery fistula following optimal medical therapy in a patient who had combined significant coronary artery spasm.

Lee S, Rha SW, Kook H, Kim DH, Oh SK, Cho DH, Kim W, Oh DJ - Korean Circ J (2013)

Bottom Line: Coronary artery fistulas (CAFs) are one of the most rare cardiac anomalies.Spontaneous regression of CAF has been reported in a few cases, almost all of which were infants.We report an adult patient who presented with ischemic chest pain due to multiple coronary arteries to pulmonary artery fistulas and combined significant CAS induced by intracoronary acetylcholine provocation test.

View Article: PubMed Central - PubMed

Affiliation: Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea.

ABSTRACT
Coronary artery fistulas (CAFs) are one of the most rare cardiac anomalies. Some patients with CAF may suffer from ischemic chest pain that originates from combined significant coronary artery spasm (CAS). Spontaneous regression of CAF has been reported in a few cases, almost all of which were infants. We report an adult patient who presented with ischemic chest pain due to multiple coronary arteries to pulmonary artery fistulas and combined significant CAS induced by intracoronary acetylcholine provocation test. Spontaneous regression of one of the fistulas was observed at 2-year angiography follow-up.

No MeSH data available.


Related in: MedlinePlus

The mid to distal left anterior descending artery and left circumflex artery showed significant diffuse vasoconstriction with chest pain after intracoronary acetylcholine injection (100 ug, A) which was reversed by nitroglycerin injection (200 ug, B).
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Figure 2: The mid to distal left anterior descending artery and left circumflex artery showed significant diffuse vasoconstriction with chest pain after intracoronary acetylcholine injection (100 ug, A) which was reversed by nitroglycerin injection (200 ug, B).

Mentions: Based on the patient's symptoms and the results of the treadmill test, we decided to perform coronary angiography. Baseline coronary angiography revealed multiple small fistulas which originated from the proximal left main (LM) coronary artery to the pulmonary artery (PA), from the proximal left anterior descending artery (LAD) to PA and from the proximal RCA to PA (Fig. 1). Because the coronary angiography showed no significant lesions in the major epicardial coronary arteries, we performed an incremental intracoronary Ach provocation test with A1 (20 ug), A2 (50 ug) and A3 (100 ug) into the left coronary artery. This showed significant diffuse vasoconstriction in the LAD and left circumflex artery with ischemic chest pain at dose A3 (Fig. 2).


Spontaneous partial regression of coronary artery fistula following optimal medical therapy in a patient who had combined significant coronary artery spasm.

Lee S, Rha SW, Kook H, Kim DH, Oh SK, Cho DH, Kim W, Oh DJ - Korean Circ J (2013)

The mid to distal left anterior descending artery and left circumflex artery showed significant diffuse vasoconstriction with chest pain after intracoronary acetylcholine injection (100 ug, A) which was reversed by nitroglycerin injection (200 ug, B).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3675312&req=5

Figure 2: The mid to distal left anterior descending artery and left circumflex artery showed significant diffuse vasoconstriction with chest pain after intracoronary acetylcholine injection (100 ug, A) which was reversed by nitroglycerin injection (200 ug, B).
Mentions: Based on the patient's symptoms and the results of the treadmill test, we decided to perform coronary angiography. Baseline coronary angiography revealed multiple small fistulas which originated from the proximal left main (LM) coronary artery to the pulmonary artery (PA), from the proximal left anterior descending artery (LAD) to PA and from the proximal RCA to PA (Fig. 1). Because the coronary angiography showed no significant lesions in the major epicardial coronary arteries, we performed an incremental intracoronary Ach provocation test with A1 (20 ug), A2 (50 ug) and A3 (100 ug) into the left coronary artery. This showed significant diffuse vasoconstriction in the LAD and left circumflex artery with ischemic chest pain at dose A3 (Fig. 2).

Bottom Line: Coronary artery fistulas (CAFs) are one of the most rare cardiac anomalies.Spontaneous regression of CAF has been reported in a few cases, almost all of which were infants.We report an adult patient who presented with ischemic chest pain due to multiple coronary arteries to pulmonary artery fistulas and combined significant CAS induced by intracoronary acetylcholine provocation test.

View Article: PubMed Central - PubMed

Affiliation: Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea.

ABSTRACT
Coronary artery fistulas (CAFs) are one of the most rare cardiac anomalies. Some patients with CAF may suffer from ischemic chest pain that originates from combined significant coronary artery spasm (CAS). Spontaneous regression of CAF has been reported in a few cases, almost all of which were infants. We report an adult patient who presented with ischemic chest pain due to multiple coronary arteries to pulmonary artery fistulas and combined significant CAS induced by intracoronary acetylcholine provocation test. Spontaneous regression of one of the fistulas was observed at 2-year angiography follow-up.

No MeSH data available.


Related in: MedlinePlus