Rupture of aneurysmal coronary-to-pulmonary artery fistula in a 96-year-old female; report of a case
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CASE REPORT
Rupture of aneurysmal coronary‑to‑pulmonary artery fistula in a 96‑year‑old female; report of a case Haruka Murakami1 · Sentaro Nakanishi1 · Aina Hirofuji1 · Hiroyuki Kamiya1 Received: 14 March 2020 / Accepted: 8 September 2020 © The Japanese Association for Thoracic Surgery 2020
Abstract Coronary artery fistula (CAF) is a relatively rare congenital abnormality of the coronary arteries; typically, patients who undergo surgery for CAFs are relatively young because it is a congenital disease. Here we present a case of an aneurysmal coronary-to-pulmonary artery fistula rupture in a 96-year-old female. Considering her extreme high age and missing preoperative diagnostics, only local hemostasis without anatomical repair was performed but the patient is still doing well 1 year after the operation. Keywords Coronary artery fistula · Rupture congenital · Nonagenarian
Introduction Coronary artery fistula (CAF) is a relatively rare congenital abnormality of the coronary arteries that afflicts 0.002% of the general population and represents 14% of all the anomalies of the coronary artery [1]. Most CAFs are asymptomatic and surgical treatment is considered if the CAF aneurysm is very large with the risk of rupture, or in the case of a significant left-to-right shunt [2]. Patients who undergo surgery for CAFs are relatively young because it is a congenital disease [1, 3]. Here we present a case of the rupture of aneurysmal coronary-to-pulmonary artery fistula in a nonagenarian female.
Case report A 96-year-old woman without known history of cardiac disease was referred to the previous hospital with complaint of chest pain. Electrocardiogram showed complete right bundle branch block and chest Xp showed moderate cardiomegaly (Fig. 1a, c). Troponin-T test was negative. A detailed examination was scheduled for a later date, and the patient * Hiroyuki Kamiya kamiya@asahikawa‑med.ac.jp 1
Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2‑1‑1‑1, Asahikawa 078‑8510, Japan
returned to her residence at a nursing facility that day. The next morning, she was found lying unconscious in her room, and was rushed to the same previous hospital. Echocardiography showed pericardial effusion (Fig. 1b), and she was diagnosed with cardiac tamponade. Pericardiocentesis was performed without much effect. It was suspected that the drainage catheter penetrated the heart, and the patient was transferred to our hospital for the management. On admission, the patient presented profound cardiogenic shock with the blood pressure of 60/40 mmHg and the heart rate of 100 /min. Emergency non-contrast CT scan showed massive cardiac tamponade. It also revealed that there was a possibility of catheter penetration of the cardiac wall (Fig. 1C), but the imagery was inconclusive. At this moment, acute myocardial infarction was thought to be unlikely because of negative troponin T and lack of ST-change in electrocardiogram and acute type A aortic dissection was thought also to be unlikely because the aorta appeared
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