Coronary fistula - an unexpected preanaesthetic finding release_3ucxwjnpinfxbo4jpxtnods7t4

by Elena-Luminiţa Stănciulescu, Silvia Iancovici, Constantin Rareş Asmarandei, Ioana Marina Grinţescu

Published in Romanian Journal of Anaesthesia and Intensive Care.

2015   Volume 22, Issue 2, p129-132


Coronary artery fistulae are congenital vascular anomalies defined as aberrant communications between a coronary artery and a cardiac chamber, large vessel or another vascular structure. In the present case the preanaesthetic clinical assessment led to a fortuitous detection of a rare coronary artery anomaly, which changed the initial therapeutic option. A 21-year-old female patient was admitted for a right ankle fracture. She had a two years history of constrictive chest pain inconsistently generated by effort of medium intensity, which had not been investigated previously. Clinical examination identified a grade V systolic-diastolic murmur audible on the entire anterior thorax, with no other abnormalities. The patient underwent cardiological evaluation including transthoracic (TTE) and transesophageal echocardiography (TEE). TTE and TEE revealed an important dilatation of the left main coronary artery (LM) and a dilated circumflex artery (CX), with a very turbulent flow and a fistulous traject drawing most probably in the right atrium. The TTE and TEE evaluation raised the suspicion of a coronaro-cavitary fistula between the CX and the right atrium. The patient underwent coronary catheterization which confirmed a coronary fistula connecting CX with a superior vena cava-right atrium junction, with a hemodynamic significant left- to-right shunt. Surgeons opted for a conservative orthopedic management of the fracture; the patient continued to present exertional chest pain and was scheduled for interventional fistula closure. Our case confirms the importance of the preanaesthetic clinical examination, as a gold standard, that was decisive in identifying this rare, but potentially lethal congenital anomaly, as it triggered a series of tests, which established the diagnosis.
In text/plain format

Archived Files and Locations

application/pdf  652.4 kB
file_fx7jfwmlvfgkbfji6u5pdqg3dq (repository) (webarchive)
Read Archived PDF
Preserved and Accessible
Type  article-journal
Stage   published
Year   2015
Language   en ?
PubMed  28913468
PMC  PMC5505373
Journal Metadata
Not in DOAJ
In Keepers Registry
ISSN-L:  2392-7518
Work Entity
access all versions, variants, and formats of this works (eg, pre-prints)
Catalog Record
Revision: d71ed74f-b85d-4de5-9660-56891611bdb8