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• W2066706037 abstract "To the Editor: We have recently seen a 23-year-old man with acute myocardial infarction and isolated coronary fistula, a phenomenon not previously reported. Myocardial ischemia has been noted in 7 percent of patients with coronary artery fistula1Daniel TM Graham TP Sabiston DC Coronary artery-right ventricular fistula with congestive heart failure: Surgical correction in the neonatal period.Surgery. 1970; 67: 985-994PubMed Google Scholar and six patients have been described2Effler DB Sheldon WC Turner JJ et al.Coronary arteriovenous fistulas: Diagnosis and surgical management; Report of fifteen cases.Surgery. 1967; 61: 41-50PubMed Google Scholar, 3Eie H Hillestad L Arteriovenous fistula of the coronary arteries, a report of six cases.Scand J Thorac Cardiovasc Surg. 1971; 5: 34-38Crossref PubMed Scopus (19) Google Scholar, 4Neufeld HN Lester RG Adams Jr, P et al.Congenital communication of a coronary artery with a cardiac chamber of the pulmonary trunk.Circulation. 1961; 24: 171-179Crossref Google Scholar, 5Symbas PN Abbott OA Hatcher Jr, CR et al.Abnormal congenital coronary arterial communications.Am Rev Resp Dis. 1968; 97: 1104-1111PubMed Google Scholar, 6Valdivia E Rowe GG Angevine DM Large congenital aneurysm of the right coronary artery.Arch Path. 1957; 63: 168-171PubMed Google Scholar where there has been previous myocardial infarction. A 23-year-old white man with no history of cardiac symptoms or known murmurs was admitted to the Veterans Administration Hospital on July 26, 1971, with a ten-hour history of sharp, heavy, very severe precordial pain, shortness of breath, and diaphoresis following extreme exertion. Physical examination showed a young man in moderate distress. Vital signs were normal. Auscultation of the heart revealed an S4 gallop and a grade 2/6 late systolic murmur at the apex. There was no evidence of congestive heart failure. Cardiac monitoring revealed irritability, as manifested by frequent premature ventricular contractions and short runs of ventricular tachycardia. Serial electrocardiograms were compatible with inferolateral infarction, probably nontransmural (Fig 1). Serial enzymes confirmed the diagnosis. The chest roentgenogram was within normal limits. Fasting blood sugar, triglyceride, and serum cholesterol levels were within normal limits, as was lipoprotein electrophoresis. The patient's condition gradually stablized and on the sixth hospital day the murmur, thought to be due to transient papillary muscle dysfunction, disappeared. By the tenth hospital day the enzymes had returned to normal. The patient was discharged without medication. He continued to experience anginal pains on moderately severe exertion and was readmitted twice for prolonged chest pains. On each occasion the electrocardiogram was unchanged and the enzymes remained normal. The patient submitted to cardiac catheterization on his fourth admission for chest pain, four months after his myocardial infarction. Intracardiac pressures were normal. The left ventricular cine-angiogram revealed a normal sized ventricle with normal myocardial contractility. The left coronary angiogram was normal. The right coronary angiogram, however, revealed a dilated and tortuous right coronary artery which at its termination communicated with the right atrium through the coronary sinus. The patient underwent surgery with the aid of cardiopulmonary bypass. Exposure of the heart through a median sternotomy incision revealed a very large, dilated right coronary sinus. There was no evidence of atherosclerosis in any of the visible coronary arteries, and no scarring from an obvious previous myocardial infarction was noted. The fistula was ligated making sure the myocardium supplied by the posterior descending coronary artery did not become ischemic. The patient made an uneventful recovery and was discharged on the 10th postoperative day. He has since refused recatheterization, but continued to be asymptomatic five months after surgery. Myocardial ischemia in patients with coronary artery fistula has been infrequent, but the possibility of myocardial infarction at any age is emphasized by this patient. Ischemic complications have been attributed to reduced blood flow in the arterial bed distal to the fistulous connection.7Hudspeth AS Linder JH Congenital coronary arteriovenous fistula.Arch Surg. 1968; 96: 832-835Crossref PubMed Scopus (16) Google Scholar Ogden and Stansel8Ogden JA Stansel Jr, HC Coronary arterial fistulas terminating in the coronary venous system.J Thorac Cardiovas Surg. 1972; 63: 172-182Google Scholar surveyed 32 patients with coronary artery fistulas terminating in the coronary venous system similar to our patient, finding seven with evidence of myocardial ischemia or infarction. Since the first successful coronary artery fistula ligation9Biorck G Crafoord C Arteriovenous aneurysm on the pulmonary artery simulating patent ductus arteriosus Botalli.Thorax. 1947; 2: 65-68Crossref PubMed Scopus (100) Google Scholar there have been 116 reported10Oldham HN Ebert PA Young WG et al.Surgical management of coronary artery fistula.Ann Thorac Surg. 1971; 12: 503-513Abstract Full Text PDF PubMed Scopus (70) Google Scholar patients with surgical closure, and only four deaths. In view of the relatively high incidence of myocardial ischemia and other serious complications and the low mortality of a potentially curative procedure, we feel that surgical repair should be performed following roentgenographic demonstration of the fistula." @default.
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• W2066706037 title "Congenital Coronary Artery Fistula with Myocardial Infarction" @default.
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• W2066706037 doi "https://doi.org/10.1378/chest.65.2.233" @default.
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