Presentation on theme: "Coronary Arteriovenous Fistula"— Presentation transcript: 1 Coronary Arteriovenous Fistula Ali Sepahdari, MD 4/6/07 2 Cardiomegaly, increased vascularity, atrial enlargement 3 Fundamental CXR approach Vessels -> Heart size INCREASED [slideplayer.com]

We report a case of coronary arteriovenous fistula with adjacent atherosclerotic plaque successfully treated with coronary stent grafting in a patient who presented with acute myocardial infarction. [ncbi.nlm.nih.gov]

• Congestive Heart Failure

  Patients with such fistulas often have loud continuous cardiac murmurs and may have congestive heart failure, myocardial ischemia (due to a coronary-artery ”steal” phenomenon), and pulmonary hypertension. [nejm.org]

  Patients may present with congestive heart failure, ischemic chest pain, or endocarditis. [ncbi.nlm.nih.gov]

• Loss of Appetite

  Nelson a, Adil Rajwani a a Cardiac Magnetic Resonance Imaging Department, Royal Adelaide Hospital, Adelaide, Australia Article A nonagenarian man with previously excellent functional status presented with progressive dyspnoea and loss of appetite. [revespcardiol.org]

• Heart Disease

  This center, one of the most respected in Europe, has experience of a wide range of congenital heart diseases both in their diagnosis and management. [books.google.de]

  Furthermore, it may be useful for the detection of shunt cases, such as congenital heart disease. [ncbi.nlm.nih.gov]

• Continuous Murmur

  The clinical symptoms and signs were feeding problem, continuous murmur, tachycardia, tachypnea, cardiomegaly, and exertional chest pain. Myocardial enzyme was elevated in 1 patient. [ncbi.nlm.nih.gov]

  Since the left ventricular systolic pressure is higher than that of aorta, flow occurs only during diastole, contributing to the diastolic murmur. CAVF should otherwise produce a continuous murmur. [cardiophile.org]

  Abstract In local experience coronary arteriovenous fistula or aortic sinus of Valsalva aneurysm rupture into the right heart are the two common causes of continuous murmurs with systolic accentuation which are maximum over the lower sternum. [annals.org]

  A loud continuous murmur heard at the lower or midsternal border of the heart suggests a coronary arteriovenous fistula; the diagnosis may be confirmed by coronary arteriography or aortography. [medical-dictionary.thefreedictionary.com]

• Exertional Chest Pain

  The clinical symptoms and signs were feeding problem, continuous murmur, tachycardia, tachypnea, cardiomegaly, and exertional chest pain. Myocardial enzyme was elevated in 1 patient. [ncbi.nlm.nih.gov]

  관상 동맥 중재술 중 Wire 손상에 합병되어 발생한 관상동맥루 1예 Abstract We report the case of a 51-year-old man who presented with worsening exertional chest pain in whom subsequent percutaneous coronary intervention resulted in a coronary arteriovenous fistula. [ekjm.org]

  A 65-year-old male patient referred to our outpatient clinic with chest pain and exertional dyspnea. The patient was suffering from retrosternal exertional chest pain for six months which relieved with rest. [openaccessjournals.com]

• Left Ventricular Dysfunction

  We repot a unique case with a fistulae originating from right coronary artery and draining into the right atrium via coronary sinus although Takotsubo-like left ventricular dysfunction or acute myocardial infarction was initially thought to have occurred [ncbi.nlm.nih.gov]

  Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction: results of the survival and ventricular enlargement trial. ‎ Página 913 - DeWood MA, Spores J, Notske R, et al. [books.google.es]

• Short Neck

  In our case, selective coronary arteriography showed that the CAVF from the left anterior descending coronary artery (LAD) was very close to the native coronary artery and had a very broad and short neck. [ncbi.nlm.nih.gov]

• Suggestibility

  Noninvasive evaluation, including transesophageal echocardiography and magnetic resonance imaging, suggested the diagnosis. Angiographic diagnosis of concomitant atherosclerotic coronary disease may be difficult, and can require postoperative study. [ncbi.nlm.nih.gov]

  Cardiac catheterization is not diagnostic, although when correlated with the clinical picture it may strongly suggest the diagnosis. Angiocardiography, particularly retrograde aortography, is diagnostic. [pediatrics.aappublications.org]

  A loud continuous murmur heard at the lower or midsternal border of the heart suggests a coronary arteriovenous fistula; the diagnosis may be confirmed by coronary arteriography or aortography. [medical-dictionary.thefreedictionary.com]

• Incontinence

  A very violent attack can result in fistula- a tear in the walls separating the vagina and the bladder or the rectum, causing incontinence and strong odours, often leading to the victim being excluded from her community. [hujiang.com]

• Sinus Arrest

  Sick sinus syndrome type III was diagnosed by paroxysmal atrial fibrillation (longest sinus arrest 9.0 sec) on 24-h Holter ECG recording. [ncbi.nlm.nih.gov]

Emergent surgical exploration and repair provided successful treatment. [ncbi.nlm.nih.gov]

There is an increase in TCC treatment of CAVF in recent years with the use of advanced interventional devices [ 21, 26 ]. [cardiothoracicsurgery.biomedcentral.com]

Jude Medical, Minnesota, USA) because the patient declined surgical treatment.. [clinmedjournals.org]

With obliteration of the fistula by suturing, the prognosis is usually excellent. Figure 1 Coronary Arteriovenous Fistula on Coronary Angiography. [nejm.org]

Patients who have undergone a closure procedure tend to have an excellent prognosis 4. [radiopaedia.org]

Rose V, Izukawa T, et al: Syndromes of asplenia and polysplenia: A review of cardiac and non-cardiac malformations in 60 cases with special reference to diagnosis and prognosis. Br Heart J, 37: 840-852, 1975. [kotobank.jp]

Prognosis: Recent results of both transcatheter and surgical approaches indicate a good prognosis. Approximately 4% of patients may require additional surgery for recurrence. Life expectancy is considered normal. [rjmatthewsmd.com]

Once patients become symptomatic, coronary AV fistulae result in a poor prognosis [ 7 ]. Early closure is recommended for symptomatic patients at all ages [ 8, 9 ]. [clinmedjournals.org]

Etiology CAVFs are most commonly congenital, but can also be rarely acquired 3,4. [radiopaedia.org]

In this case, given the absence of localising findings, potential etiologies include isolated congenital fistulae or atherosclerotic aneurysm. [revespcardiol.org]

The coronary artery fistula’s etiology is not very well known, but most of the fistulas have a congenital origin. [romanianjournalcardiology.ro]

[…] closure of distal fistulashas been associated with a high incidence of latethrombosis of the permanently dilated and tortuousproximal coronary artery. 5 Closure of the fistula results inrelative stasis in the giant coronary artery, and this is likelythe etiology [citoday.com]

"Epidemiology, clinical presentation, diagnostic evaluation, and prognosis of cerebral dural arteriovenous fistulas". Handb Clin Neurol. 143 : 99–105. doi : 10.1016/B978-0-444-63640-9.00009-6. PMID 28552162. ↑ Newton TH, Cronqvist S (November 1969). [wikidoc.org]

Grasp the full scope of the pathophysiology of CHD with well-organized, expert guidance. Quickly search the contents online, download images in JPG or PPT format, and view 70 echocardiogram videos at expertconsult.com. [books.google.de]

This contrasts with coronary arteriovenous fistulae in the absence of outflow obstruction, in which coronary steal is the primary pathophysiologic problem. [emedicine.medscape.com]

The objective of this study was to describe aspects of the natural history and pathophysiology of CAVF and to propose potential treatment strategies. [cardiothoracicsurgery.biomedcentral.com]

Coronary artery bypass grafting Pathophysiology: The pathophysiologic mechanism of CAF is myocardial stealing or reduction in myocardial blood flow distal to the site of the CAF connection. [rjmatthewsmd.com]

"Large A-V fistula: pathophysiological consequences and therapeutic perspectives". Curr Vasc Pharmacol. 1 (3): 347–54. [wikidoc.org]

As the fistula was very large and to prevent its complications, it was planned to close the fistula percutaneously. [ncbi.nlm.nih.gov]

Transthoracic echocardiography could be used to diagnose CAVF, but poor acoustic penetration and low preoperative suspicion may prevent the identification of this uncommon coronary artery anomaly ( 2 ). [journals.lww.com]

The goals of treatment arethreefold: (1) improvement of dyspnea/hypoxemia, (2)prevention of lung hemorrhage, and (3) prevention ofneurologic sequelae. Diagnosis. [citoday.com]

Specific inhibitors and promoters of calcium action in the excitation-contraction coupling of heart muscle and their role in the prevention or production of myocardial lesions. In Calcium and the Heart, ed. ‎ [books.google.es]