Sinus Node Dysfunction After Percutaneous Transcatheter Closure of Right Coronary Artery–Superior Vena Cava Fistula
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Abstract:
Congenital right coronary artery-superior vena cava (RCA-SVC) fistula is rare and typically does not manifest any symptoms until the fifth decade of life. The present case demonstrates a 48-year-old woman who developed Sinus node dysfunction of unknown cause after Percutaneous coil embolization of the RCA-SVC fistula requiring permanent pacemaker. (Level of Difficulty: Intermediate.).Keywords:
Sinus (botany)
Coronary artery variations are considered to be important as they may lead to or predispose the patients to develop myocardial ischemia or sudden cardiac death. We report an anatomic variation with independent origin of the entire coronary system along with the right conus artery within the right sinus of valsalva and intramyocardial tunneling of the anterior descending branch of the right coronary artery which is very rare. The present case contributes to better understanding of the coronary artery variations as this type of combined anatomical variation of the coronary arteries has not been described in the literature before.
Sinus (botany)
Conus
Coronary arteries
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Anomalous origin of the left coronary artery from the right sinus of Valsalva is a congenital anomaly When the left coronary artery (LCA) originates from the right sinus of Valsalva, the anomalous artery pathway can present in four variants. We report a case in which a patient presented with episodes of atypical chest pain and during coronary angiography it was found that his left coronary artery originated anomalously from the right coronary sinus and course of the LCA was confirmed by CT coronary angiography. Importance of anomalous origin of coronary artery and specially its course shall be discussed in this case report.
Coronary artery anomaly
Left coronary artery
Sinus (botany)
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Coronary artery fistula is a rare congenital heart disease that is defined as an abnormal connection between a coronary artery and a cardiac vessel or cardiac chamber. Most coronary artery fistulas involve the right coronary artery draining into the right-sided heart structures. We present a patient with right coronary artery to coronary sinus fistula diagnosed by coronary angiography. The surgical approach of retrograde cardioplegia and transatrial resection allowed for protection of the myocardium and definitive visualization and closure of the abnormal fistula.
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Coronary artery fistulae that communicate with the left ventricle are quite rare; those accompanied by sinus-node dysfunction are even more unusual. We report 2 cases of congenital coronary-artery-to-left-ventricle fistula with sinus-node dysfunction. In each of these patients, fistulae arose from both left and right coronary arteries. One patient had, in addition, a right coronary artery fistula that communicated with his right ventricle. Sinusnode dysfunction encountered in these 2 patients was likely caused by chronic general ischemia arising from a steal syndrome associated with the fistulae.
Sinus (botany)
Left coronary artery
Coronary arteries
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There is a slight predominance for coronary artery fistulas that involve the right coronary artery, while multiple fistulas have also been reported. The usual site of termination is one or more of the low‐pressure structures in the heart or the great vessels such as the right or left atria, right ventricle, coronary sinus, pulmonary artery, or superior vena cava. However, a coronary fistula that drains into a hepatic vein has not been reported in the literature. Therefore, this is the first case report indicating a right coronary artery fistula that drains into the middle hepatic vein.
Left coronary artery
Great cardiac vein
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Objective:To investigate the patterns of anomalous origin of the coronary artery and frequency of occurrence in adult undergoing coronary arteriography.Methods:The data from 690 cases of cases of coronary arteriography were reviewed and analyzed retrospectively.Results:Among 690 patients,10 cases were found to have anomalous origin of the coronary artery,the detectable rate was 1.4%.Anomalous origin of the right coronary artery(RCA)was 6 cases(6/10),RCA was found to originate from the none sinus of Valsalva in 3 cases,from the left sinus of Valsalva in 1 case,from the the ascending aorta in 3 cases.Anomalous origin of the left coronary artery(LCA)was 3 cases(3/10),LCA was found to originate from the right sinus of Valsalva in 1 case,from the RCA in 1 case,from the the ascending aorta in 1 case.Conclusion:Coronary arteriography is the most important method for accurate diagnosis of various patterns of anomalous origin of the coronary artery,the total detectable rate of this study to that of existed studies.
Sinus (botany)
Left coronary artery
Aortic sinus
Coronary arteries
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Coronary arteries
Left coronary artery
Lumen (anatomy)
Circumflex
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Limb loss
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Ruptured aneurysms of the sinus of Valsalva with a gigantic fistulous tract are extremely rare. A single origin of the coronary arteries is a rare coronary anomaly. We describe the case of a 6-year-old girl who had a ruptured aneurysm of the right coronary sinus with a gigantic fistulous tract and an anomalous origin of the right coronary artery. Transthoracic echocardiography showed the right coronary artery (RCA) aneurysm and RCA fistula connecting to the right ventricular (RV). Aortography revealed the presence of a right coronary sinus of Valsalva aneurysm (SVA)-RV fistula and the originating of right coronary artery (RCA) from left circumflex artery (LCX). She was diagnosed as having a gigantic SVA to right ventricle fistula and a single origin of the coronary arteries. Successful trancatheter closure of the fistulous ostium was performed.
Sinus (botany)
Circumflex
Aortography
Coronary arteries
Ostium
Aortic sinus
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Conus
Sinus (botany)
Left coronary artery
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