%0 Journal Article
%T Apical Hypertrophic Cardiomyopathy and Multiple Coronary Artery-left Ventricular Fistulas: A Case Report. - Apical Hypertrophic Cardiomyopathy and Multiple Coronary Artery-left Ventricular Fistulas: A Case Report. - Open Access Pub
%A Francesco Tota
%A Ilaria Dentamaro
%A Marco Matteo Ciccone
%A Marco Sassara
%A Maria Tesorio
%A Massimo Ruggiero
%A Nicola Locuratolo
%A Pasquale Caldarola
%A Pietro Scicchitano
%A Vito Calvani
%J OAP | Home | Journal of Hypertension and Cardiology | Open Access Pub
%D 2017
%X We describe a rare case of multiple coronary artery-left ventricular fistulas associated with apical hypertrophic cardiomyopathy in a 62 year asymptomatic old male admitted to our department for a perioperative evaluation of non cardiac surgery, already diagnosed for multiple coronary artery-left fistulae. He underwent transthoracic echocardiography and then to accelerated dipiridamole stress-echo. DOI 10.14302/issn.2329-9487.jhc-12-153 A 62 years old man six years ago underwent coronary angiography due to atypical chest pain. No coronary stenosis was observed while multiple coronary fistula coming from middle tract of left anterior descending (LAD) artery and draining to left ventricle cavity were detected (Figure 1). At discharged, he undertook antiaggregant therapy and no fistula¡¯s closure indication was advised. Figure 1. A/B. Left anterior descending artery fistula in left ventricular cavity: an angiography perspective. We now cardiologically evaluated him before an elective inguinal hernia intervention. He had no sudden cardiovascular death familiarity, nor cardiovascular risk factors. He was asymptomatic, in good general conditions, blood pressure 120/80 mmHg, no murmurs. The electrocardiogram showed sinus bradycardia (55 bpm) and left ventricular hypertrophy signs (deep and symmetric negative T waves in DI, aVL, V2 till V6). Echocardiogram (VIVID 7, 2-4 MHz probe) showed non classical apical hypertrophic cardiomyopathy (Figure 2), localized at anterior, lateral and posterior apex (septum was preserved), with no obliteration of apical cavity. By mean of color-Doppler evaluation, we observed multiple and thin color flows from LAD draining into apical region. Pulse-wave Doppler temporization was exclusively diastolic (Figure 3). Stress echocardiography with accelerate dipyridamole resulted negative for inducible ischemia and no variation in fistula flow was detectable. Inguinal hernia intervention was safely performed and the patient was advised to undergo periodical cardiologic controls. Figure 2. Echocardiogram image of non classical apical hypertrophic cardiomyopathy of the patient. Figure 3. Echo-color Doppler evalutation of left anterior descending artery fistula draining in left ventricular cavity Coronary fistula are the most frequent congenital coronary anomalies, observed in 0.2% of coronary angiographies 1,2. In 20% of cases, they are associated with other heart congenital abnormalities characterized by obstacles to the efflux. In 90% of cases, their drainage went to right cardiac section; in 40-60% of cases right coronary is the origin
%U https://www.openaccesspub.org/jhc/article/36