RARE ANOMALY OF THE CORONARY VESSELS: CORONARY AND LEFT VENTRICULAR FISTULAS

Study objective: description of the case of diagnostics of rare anomaly of the coronary vessels: coronary and left ventricular fistulas.

Materials and methods. Patient L., 45 y.o. (height 168 cm, weight 55 kg), male, complained of periodical burning pain behind the breastbone without connection with physical activity, often disturbing at night, stopped with intake of nitrates. The following examination of the patient was performed: clinical and biochemical blood tests, electrocardiography (ECG), Holter ECG monitoring, bicycle ergometry, echocardiography, coronary angiography, computerized tomography.

Results. The following clinical diagnosis was set on the basis of complaints. data of objective and instrumental examination: congenital heart disease. Abnormal end of the coronary arteries: multiple coronary and left ventricular fistulas, steal syndrome. Hypoplasia of the right coronary artery (Q 24.5 in accordance with the International Classification of Diseases, revision 10). Coronary angiography has become the main diagnostic method that allowed diagnosis verification: left type of coronary blood circulation. The trunk of the left coronary artery, the anterior interventricular branch,  he diagonal branch, the envelope branch, the obtuse marginal branch, the right coronary artery, the posterior interventricular branch have with irregular contours. Direct abnormal connection (dense grid of fistulas) is observed in the medium and lower third of the anterior interventricular branch with the left ventricle cavity. The contrast agent practically completely comes into the left ventricular cavity. The parenchymal phase is very well expressed; the venous phase is not visualized. Conclusion. Congenital heart disease: multiple coronary and left ventricular fistulas. No angiographic evidence of hemodynamically significant stenotic coronary lesions.

Conclusion. The practical interest of this observation is due to rarity of disease, analysis of modern possibilities of diagnostics and complexity of the choice of the therapy tactics. Surgical correction of the disorder has appeared impossible due to large area of discharge and too dense grid of fistulas. Medication therapy has been selected that allowed stopping the pain syndrome, which is the major clinical manifestation of the congenital anomaly of coronary vessels: multiple coronary and left ventricular fistulas.

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