Answer for BIR CoW 03 June 2018
Coronary cameral fistula
Findings
Co dominance Cardiomegaly Dilated left sinus of valsalva. Separate origin of left Circumflex artery and left anterior descending artery from left sinus of valsalva. Irregular fusiform aneurysmal dilatation of left Circumflex noted along its entire course (including distal segments). No intra luminal filling defect. Posterolateral branch supplying inferior wall of left ventricle – seen arising from Left circumflex artery PDA seen arising from right coronary artery. Short segment of dilated coronary sinus seen in inferior AV groove. Termination of coronary sinus in to right atrium not visualized.
Discussion
A coronary cameral fistula is a communication between a coronaryartery and a chamber of the heart. A coronary artery fistula most commonly originates from the right coronary artery Fistula from left coronary arteryis rare Major sites of termination include the right side of the heart (90%), left ventricle, left atrium and the coronary sinus. The most frequent sites of termination in the right side of the heart, in descending order, are the right ventricle, right atrium, and pulmonary vasculature. Larger fistulae can cause coronary artery steal phenomenon, which leads to ischemia of the segment of the myocardium perfused by the coronary artery. The pathophysiologic mechanism of coronary artery fistula is myocardial stealing or reduction in myocardial blood flow distal to the site of the coronary artery fistula connection. The mechanism is related to the diastolic pressure gradient and runoff from the coronary vasculature to a low-pressure receiving cavity. If the fistula is large, the intracoronary diastolic perfusion pressure progressively diminishes
TYPES : Congenital coronary artery fistula Acquired coronary artery fistula SYMPTOMS Irritability, diaphoresis, pallor, tachypnea, and tachycardia. Older patients may present with signs of low-output congestive heart failure, arrhythmias, syncope, chest pain, and, rarely, endocarditis
References: Circumstances of out of hospital cardiac arrest in patients with ischaemic heart disease R M Norris, on behalf of the UK Heart Attack Study (UKHAS) Collaborative Group A case of coronary cameral fistula - Gareth J. PadfieldEuropean Journal of Echocardiography, Volume 10, Issue 5, 1 July 2009, Pages 718–720,
Findings
Co dominance Cardiomegaly Dilated left sinus of valsalva. Separate origin of left Circumflex artery and left anterior descending artery from left sinus of valsalva. Irregular fusiform aneurysmal dilatation of left Circumflex noted along its entire course (including distal segments). No intra luminal filling defect. Posterolateral branch supplying inferior wall of left ventricle – seen arising from Left circumflex artery PDA seen arising from right coronary artery. Short segment of dilated coronary sinus seen in inferior AV groove. Termination of coronary sinus in to right atrium not visualized.
Discussion
A coronary cameral fistula is a communication between a coronaryartery and a chamber of the heart. A coronary artery fistula most commonly originates from the right coronary artery Fistula from left coronary arteryis rare Major sites of termination include the right side of the heart (90%), left ventricle, left atrium and the coronary sinus. The most frequent sites of termination in the right side of the heart, in descending order, are the right ventricle, right atrium, and pulmonary vasculature. Larger fistulae can cause coronary artery steal phenomenon, which leads to ischemia of the segment of the myocardium perfused by the coronary artery. The pathophysiologic mechanism of coronary artery fistula is myocardial stealing or reduction in myocardial blood flow distal to the site of the coronary artery fistula connection. The mechanism is related to the diastolic pressure gradient and runoff from the coronary vasculature to a low-pressure receiving cavity. If the fistula is large, the intracoronary diastolic perfusion pressure progressively diminishes
TYPES : Congenital coronary artery fistula Acquired coronary artery fistula SYMPTOMS Irritability, diaphoresis, pallor, tachypnea, and tachycardia. Older patients may present with signs of low-output congestive heart failure, arrhythmias, syncope, chest pain, and, rarely, endocarditis
References: Circumstances of out of hospital cardiac arrest in patients with ischaemic heart disease R M Norris, on behalf of the UK Heart Attack Study (UKHAS) Collaborative Group A case of coronary cameral fistula - Gareth J. PadfieldEuropean Journal of Echocardiography, Volume 10, Issue 5, 1 July 2009, Pages 718–720,
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!