Project description:Myxomas are benign and the most common tumors of the cardiac muscle (Reynen, 1995). They are predominantly located in the left atrium. Clinical manifestations may vary according to the localization and the size of the myxoma. On the other hand, imaging of a myxoma by contrast dye during coronary angiography is a rare sign, which displays the vascular supply of the tumor. Here, we report the case of a 51-year-old man presenting with presyncope and palpitations due to a giant left atrial myxoma having its vascular supply from the right coronary artery (RCA).
Project description:Primary cardiac tumors are rare and approximately half of them are atrial myxomas. They rarely remain asymptomatic, especially if large. The imaging of a myxoma by contrast dye during coronary angiography is an infrequent sign, which clarifies the vascular supply of the tumor. We report herein an interesting and rare case of a left atrial myxoma hypervascularized from the right coronary artery.
Project description:BackgroundCoronary artery fistula complicated with giant coronary artery ectasia (CAE) is a rare cardiac malformation, and its surgical indications and treatment strategies still need further discussion.Case summaryIn this case, a 41-year-old man had complained of occasional dizziness for 2 years, but he did not seek medical attention until he started to feel palpitations. A right coronary artery (RCA)-left ventricular (LV) fistula with giant RCA of diffuse ectasia was firstly revealed by transthoracic echocardiography. A widened left ventricle and significantly constricted right atrium and right ventricle were also detected by three-dimensional coronary artery computed tomography. Surgical treatment, including the repair of the RCA-LV fistula, the resection and reconstruction of the dilated RCA and coronary artery bypass grafting (CABG) under hypothermic cardiopulmonary bypass, were performed to correct the malformation. The patient presented a favourable health condition without any discomfort at the 1-year follow-up.DiscussionCAE can be caused by various congenital or acquired factors. Surgical treatment, such as transcatheter embolization excision, surgical ligation or resection for symptomatic patients with CAE three times or larger than the reference diameter, has been reported to have satisfactory results. Additionally, CABG can be selected if myocardial perfusion is compromised and the distal branch is of reasonable size. In this case, the giant ectasia of the RCA may have been a consequence of the congenital RCA-LV fistula. Atherosclerosis, with calcified plaques in the RCA, and the patient's long-term history of smoking may have contributed to the development of giant ectasia of the RCA.
Project description:Congenital anomalies of coronary arteries are a group of diseases that are infrequently found. Their prevalence has been reported from 0.6% to 1.3%. Most clinical manifestations are benign and asymptomatic. Congenital absence of the left circumflex artery is a very rare congenital anomaly of the coronary circulation, and only a few cases have been reported in the literature. We report a case of a 51-year-old man who underwent a cardiac catheterisation. Coronary angiography showed a left anterior descending coronary artery with no circumflex and a dominant right coronary artery.
Project description:A 50-year-old female patient presented with a "dumbbell" giant right coronary artery ectasia, characterized by two artery dilation segments both reaching the level of a giant aneurysm with a normal segment between them. Computed tomography angiography showed a fistula sac in the right atrium. The vessel shape was a typical type IV (localized or segmental) coronary artery ectasia, which is rarely seen on true imaging. The patient had a 3-year history of chest tightness, without dyspnea, worsened by physical activity. Additional tests indicated that she had mitral valve regurgitation, superficial myocardial bridge, and anemia, all of which led to the development of her symptoms. She felt relieved after successful coronary artery fistula repair, mitral valvuloplasty, and fistula sac removal. At the 6-month follow-up, no complications were found according to echocardiography. Patients with coronary aneurysms can be asymptomatic in the early stage, while this case indicates that the dumbbell shape may be a developing stage of giant coronary aneurysm whose origin and close-fistula segments are influenced by separate hydrodynamics during ectasia or aneurysm formation.
Project description:A 68-year-old male with a history of hypertension and hypercholesterolemia presented with recurrent episodes of chest discomfort. A 12-lead ECG and an echocardiogram were normal. A myocardial perfusion study could not rule out ischemia in the inferior wall. At coronary angiography using the transradial approach, the right coronary artery (RCA) could not be visualized. Angiography of the left coronary system demonstrated non-obstructive atherosclerosis involving the mid segment of the left anterior descending (LAD) artery and a normal circumflex (Cx) artery. The RCA originated from the mid LAD segment distal to the first septal perforator and the first diagonal branch and was free of atherosclerosis disease. A contrast-enhanced 64-slice multi-detector cardiac computed tomography showed that the LAD was severely calcified in the proximal part, and the RCA coursed anterior to the right ventricular outflow tract (RVOT) to reach the right atrioventricular groove. The patient was managed medically and became asymptomatic.
Project description:Diffuse and multiple coronary cameral fistulas are very rare and with very few case reports of its association with left ventricular noncompaction are published. Here, we report a 6-year-old child of multiple diffuse coronary cameral fistulas to both the right and left ventricle in association with the left ventricular noncompaction. A possible common embryological link between the two uncommon entities is also discussed.