Left main coronary artery to left atrial fistula causing mild pulmonary hypertension.

Abstract

HomeCirculationVol. 103, No. 15Left Main Coronary Artery to Left Atrial Fistula Causing Mild Pulmonary Hypertension Free AccessOtherPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyRedditDiggEmail Jump toFree AccessOtherPDF/EPUBLeft Main Coronary Artery to Left Atrial Fistula Causing Mild Pulmonary Hypertension Dimitris Tousoulis, Stella Brilli, Konstantina Aggelli, Costas Tentolouris, Christodoulos Stefanadis, Kostantinos Toutouzas, Alexandra Frogoudaki and Pavlos Toutouzas Dimitris TousoulisDimitris Tousoulis From the Cardiology Unit, Athens University Medical School, Hippokration Hospital, Athens, Greece. Search for more papers by this author , Stella BrilliStella Brilli From the Cardiology Unit, Athens University Medical School, Hippokration Hospital, Athens, Greece. Search for more papers by this author , Konstantina AggelliKonstantina Aggelli From the Cardiology Unit, Athens University Medical School, Hippokration Hospital, Athens, Greece. Search for more papers by this author , Costas TentolourisCostas Tentolouris From the Cardiology Unit, Athens University Medical School, Hippokration Hospital, Athens, Greece. Search for more papers by this author , Christodoulos StefanadisChristodoulos Stefanadis From the Cardiology Unit, Athens University Medical School, Hippokration Hospital, Athens, Greece. Search for more papers by this author , Kostantinos ToutouzasKostantinos Toutouzas From the Cardiology Unit, Athens University Medical School, Hippokration Hospital, Athens, Greece. Search for more papers by this author , Alexandra FrogoudakiAlexandra Frogoudaki From the Cardiology Unit, Athens University Medical School, Hippokration Hospital, Athens, Greece. Search for more papers by this author and Pavlos ToutouzasPavlos Toutouzas From the Cardiology Unit, Athens University Medical School, Hippokration Hospital, Athens, Greece. Search for more papers by this author Originally published17 Apr 2001https://doi.org/10.1161/01.CIR.103.15.2028Circulation. 2001;103:2028–2029A 73-year-old man with a 6-month history of exertional chest tightness and dyspnea was referred for evaluation. No risk factors for coronary atherosclerosis were present. Left cardiac catheterization revealed coronary arteries without significant stenoses and mildly impaired left ventricular function (ejection fraction, 55%). A fistula from the main stem of the left coronary artery to the left atrium was visualized during coronary arteriography (Figure 1). Right cardiac catheterization showed the following: pulmonary artery pressure of 45/22 mm Hg (mean, 30 mm Hg), right ventricular pressure of 45/8 mm Hg, and mean pulmonary capillary wedge pressure of 14 mm Hg (V wave, 30 mm Hg). Echocardiography showed an increased left atrial diameter (49 mm) and normal thickness and dimensions of the left ventricle (end-diastolic diameter of 50 mm and end-systolic diameter of 35 mm). A transesophageal echocardiogram in the short-axis projection revealed abnormal flow across the aortic wall into the left atrium (Figure 2). Pulsed Doppler revealed continuous flow at the left atrial end of the fistula (Figure 3). In this case, the symptoms were controlled with a diuretic and an ACE inhibitor, and a follow-up echocardiogram was arranged. Download figureDownload PowerPoint Figure 1. Angiogram with catheter tip in left coronary artery. Fistula (arrows) from main stem of left coronary artery (arrow A) to the left atrium (arrow B) is evident.Download figureDownload PowerPoint Figure 2. Transesophageal echocardiogram in short-axis projection shows abnormal flow across aortic wall into left atrium (arrows).Download figureDownload PowerPoint Figure 3. Pulsed Doppler reveals continuous flow at left atrial end of fistula.FootnotesCorrespondence to Dimitris Tousoulis, MD, PhD, Athens University Medical School, S Karagiorga 69, 16675 Athens, Greece. Previous Back to top Next FiguresReferencesRelatedDetailsCited By Chang Y, Chan S, Chai J, Chen J, Fu Y, Chen J, Lin Y, Chen M and Chen C (2016) Pulmonary hypertension and right ventricular dysfunction in patients with left to right shunt coronary artery fistula: evaluation with cardiac CT, The International Journal of Cardiovascular Imaging, 10.1007/s10554-016-0868-2, 32:S1, (91-104), Online publication date: 1-Jun-2016. Said S, Koomen E and Bos J (2011) Gender-related differences in octogenarians with congenital coronary artery fistula: a report of two cases and a review, Netherlands Heart Journal, 10.1007/s12471-011-0199-9, 19:12, (523-530), Online publication date: 1-Dec-2011. April 17, 2001Vol 103, Issue 15Article InformationMetrics Copyright © 2001 by American Heart Associationhttps://doi.org/10.1161/01.CIR.103.15.2028 Originally publishedApril 17, 2001 PDF download Advertisement