Browse
Submit Data
Databases
API
Help

Dataset Information

14 Views

0 Connections

0 Citations

0 Reanalyses

0 Downloads

Omics score: 0

Interpretation of coronary steal syndrome and haemodynamic changes after surgical closure of coronary fistula using Doppler wire and computational fluid dynamics analysis: a case report.

ABSTRACT:

Background

Coronary arteriovenous fistulas (CAFs) are rare but can cause myocardial ischaemia and other complications. However, the haemodynamic and physiologic characteristics of significant CAFs requiring treatment are poorly described. We report a case of CAF causing coronary steal syndrome in which haemodynamic changes were assessed before and after surgical closure using a Doppler wire and computational fluid dynamics (CFD) technique.

Case summary

A 51-year-old woman presented with exertional chest pain for 3 years. Progressive dyspnoea occurred with exertion. Treadmill and cardiopulmonary exercise tests showed suspicious myocardial ischaemia. Coronary angiography and contrast-enhanced coronary computed tomography angiography (CCTA) revealed a coronary fistula arising from the distal left main coronary artery that drained into the pulmonary artery trunk. We observed a persistent coronary steal phenomenon at baseline and during hyperaemia and a systolic dominant flow rate pattern inside the CAF by Doppler wire-based flow rate measurement. According to CFD analysis based on CCTA, low wall shear stress and a high focal oscillatory shear index were observed at the ostial sites of aneurysmal sacs in the CAF. After successful surgical closure of the CAF, the vessel sizes and flow rate distributions of the coronary arteries increased.

Discussion

Doppler wire-based flow rate distribution measurements and CFD analysis may facilitate the identification of significant coronary steal syndrome requiring closure and the evaluation of future risks of life-threatening complications such as thrombosis and rupture.

SUBMITTER: Lee KY

PROVIDER: S-EPMC8188863 | biostudies-literature |

REPOSITORIES: biostudies-literature

ACCESS DATA

Json Xml

Similar Datasets

Coronary-Bronchial Fistula: Coil the Steal.

Project description:Coronary artery fistula is a rare coronary anomaly with communication between the coronary artery and either the cardiac chamber or other vessels. We present a case of coronary-to-bronchial artery fistula that resulted in likely coronary artery steal and was treated with coil embolization. (Level of Difficulty: Beginner.).

| S-EPMC8353563 | biostudies-literature

Left atrial appendage enlarged by coronary artery fistula after surgical closure of appendage.

Project description:Two years previously, a 73-year-old man with mitral regurgitation underwent mitral annuloplasty and left atrial appendage (LAA) exclusion by suturing the orifice from the endocardium. However, the mitral regurgitation became exacerbated, and the left atrium enlarged rapidly over a 6-month period. Computed tomography showed a heterogenic mass in the LAA, and coronary angiography revealed a coronary artery-LAA fistula. Reoperation revealed a thrombus filling the appendage and two small orifices of the coronary artery-LAA fistula located in the endocardium of the appendage. We excised the LAA and closed these fistula orifices concomitant with mitral valve replacement.

| S-EPMC4360659 | biostudies-other

Acute Myocardial Infarction After Surgical Closure of Coronary Artery Fistula : Importance of Anticoagulant Therapy

Project description:We present a case of a coronary arteriovenous fistula between the left circumflex (LCX) and the atrium with LCX ectasia. Four months after surgical closure of the fistula, the patient experienced acute myocardial infarction caused by thrombosis in the LCX. Antiplatelet drugs were replaced with anticoagulant agents, and the patient was followed up without adverse events. (Level of Difficulty: Advanced.) Central Illustration

| S-EPMC9207945 | biostudies-literature

Role of transesophageal echocardiography in surgical retrieval of embolized amplatzer device and closure of coronary-cameral fistula.

Project description:Congenital coronary artery fistula is an uncommon anomaly. Transcatheter coil embolization or Amplatzer vascular plug device closure of fistula is often done in symptomatic patients with safe accessibility to the feeding coronary artery. Embolization of Amplatzer vascular plug device is rare. We report an 11-year-old male child who presented to us with increasing shortness of breath for 7 years. He had a history of Amplatzer vascular plug device closure of right coronary-cameral fistula 8 years back. Echocardiography demonstrated a dilated aneurysmal right coronary artery with turbulent jet entering into the right ventricle (RV) and device embolized into the left pulmonary artery (LPA). Cardiac catheterization eventually confirmed the diagnosis. Surgical closure of fistula and retrieval of device was done using cardiopulmonary bypass. Intraoperatively transesophageal echocardiogram helped in localizing fistula opening in the RV below the anterior leaflet of tricuspid valve, continuous monitoring to prevent further distal embolization of the device during surgical handling, and assessment of completeness of repair of the fistula and LPA following retrieval of the device.

| S-EPMC5535581 | biostudies-literature

Rare Cause of Late Recurrent Angina following Coronary Artery Bypass Grafting: Iatrogenic Aortocoronary Arteriovenous Fistula Causing Coronary Steal.

Project description:Iatrogenic aortocoronary arteriovenous fistula is a very rare complication of coronary artery bypass grafting in which one of the arterial grafts inadvertently forms a fistulous tract with a cardiac vein, shunting blood from the anastomosed coronary artery. We report a patient with an iatrogenic left internal mammary artery graft to cardiac vein fistula presenting with recurrent angina three years after a three-vessel coronary artery bypass grafting.

| S-EPMC6035848 | biostudies-literature

Coronary subclavian steal.

Project description: Not available

| S-EPMC10834904 | biostudies-literature

Transcatheter Closure of Complex Left Circumflex to Coronary Sinus Fistula.

Project description:Coronary artery fistulae connecting the left circumflex to the coronary sinus are rare. Surgical closure of coronary sinus connections is technically challenging because of the location, especially in high-risk surgical patients. We used multimodality imaging to delineate the drainage site and successfully closed a left circumflex to coronary sinus fistula using a transcatheter closure technique. (Level of Difficulty: Advanced.).

| S-EPMC9091539 | biostudies-literature

Case report: Percoronary device closure of tortuous coronary artery fistula into left atrium.

Project description:Surgical ligation and transcatheter occlusion are the mainstream for the treatment of coronary artery fistulas (CAFs). However, these techniques applied to tortuous and aneurysmal CAF, especially those draining into left-heart, have their known drawbacks. We report, a successful percoronary device closure of such CAF, originating from left main coronary artery and draining into left atrium, through a left subaxillary minithoracotomy. Through a puncture on the distal straight course, we occluded CAF exclusively under transesophageal echocardiography guidance. Complete occlusion was achieved. It's a simple, safe, and effective alternative for tortuous, large, and aneurysmal CAFs draining into the left heart.

| S-EPMC9971947 | biostudies-literature

Algorithmic Versus Expert Human Interpretation of Instantaneous Wave-Free Ratio Coronary Pressure-Wire Pull Back Data.

Project description:ObjectivesThe aim of this study was to investigate whether algorithmic interpretation (AI) of instantaneous wave-free ratio (iFR) pressure-wire pull back data would be noninferior to expert human interpretation.BackgroundInterpretation of iFR pressure-wire pull back data can be complex and is subjective.MethodsFifteen human experts interpreted 1,008 iFR pull back traces (691 unique, 317 duplicate). For each trace, experts determined the hemodynamic appropriateness for percutaneous coronary intervention (PCI) and, in such cases, the optimal physiological strategy for PCI. The heart team (HT) interpretation was determined by consensus of the individual expert opinions. The same 1,008 pull back traces were also interpreted algorithmically. The coprimary hypotheses of this study were that AI would be noninferior to the interpretation of the median expert human in determining: 1) the hemodynamic appropriateness for PCI; and 2) the physiological strategy for PCI.ResultsRegarding the hemodynamic appropriateness for PCI, the median expert human demonstrated 89.3% agreement with the HT in comparison with 89.4% for AI (p < 0.01 for noninferiority). Across the 372 cases judged as hemodynamically appropriate for PCI according to the HT, the median expert human demonstrated 88.8% agreement with the HT in comparison with 89.7% for AI (p < 0.0001 for noninferiority). On reproducibility testing, the HT opinion itself changed 1 in 10 times for both the appropriateness for PCI and the physiological PCI strategy. In contrast, AI showed no change.ConclusionsAI of iFR pressure-wire pull back data was noninferior to expert human interpretation in determining both the hemodynamic appropriateness for PCI and the optimal physiological strategy for PCI.

| S-EPMC6645043 | biostudies-literature

Transcatheter Closure of Left Ventricle to Coronary Sinus Fistula Post-MVR and Septal Myectomy.

Project description:This paper describes the case of a patient who developed refractory heart failure due to a fistula from the left ventricle to the coronary sinus that was unintentionally created after a surgical myectomy and mitral valve replacement. Advanced image guidance with a pre-procedure 3-dimensional physical model and intraprocedure echocardiography fusion facilitated transcatheter plugging of the shunt with symptom resolution. (Level of Difficulty: Advanced.).

| S-EPMC8387808 | biostudies-literature

OmicsDI is part of the ELIXIR infrastructure

OmicsDI is an Elixir interoperability service. Learn more ›

Tweets

OmicsDI Databases

PRIDE
PeptideAtlas
MassIVE
JPOST Repository
Physiome Model Repository

EGA
EVA
ENA
LINCS
PAXDB
Cell Collective

MetaboLights
Metabolomics Workbench
MetabolomeExpress
GNPS
BioModels
FAIRDOMHub

ArrayExpress
dbGaP
ExpressionAtlas
GEO
NODE

Information

Databases
Help
API
Contact us
Code on GitHub
Terms of use
Submit Data