Image in Cardiology
Collateral damage from a coronary blush
Danos colaterais com blush coronário
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"tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "747" "paginaFinal" => "749" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Panagiotis Koudounis, Jessica Webb, Camila Cabral, Natali Chung, Ronak Rajani" "autores" => array:5 [ 0 => array:3 [ "nombre" => "Panagiotis" "apellidos" => "Koudounis" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Jessica" "apellidos" => "Webb" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Camila" "apellidos" => "Cabral" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Natali" "apellidos" => "Chung" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:4 [ "nombre" => "Ronak" "apellidos" => "Rajani" "email" => array:1 [ 0 => "Ronak.Rajani@gstt.nhs.uk" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Cardiology, Guy's and St Thomas’ Hospitals, London SE1 7EH, United Kingdom" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Adult Congenital Heart Disease, Guy's and St Thomas’ Hospitals Trust, SE1 7EH, United Kingdom" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Danos colaterais com <span class="elsevierStyleItalic">blush</span> coronário" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 3480 "Ancho" => 2334 "Tamanyo" => 688212 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(a–c) Three-dimensional volume rendered cardiac computed tomography images showing the relationship of the coronary artery fistula (arrow) to the right ventricular outflow tract, aorta and main pulmonary artery in anterior (a), anterolateral (b) and lateral (c) planes; (d) curved multiplanar reformatted cardiac computed tomographic image showing the course of the coronary artery fistula anterior to the right ventricular outflow tract; (e) multiplanar reformatted cardiac computed tomographic image showing the presence of a non-calcified bicuspid aortic valve; (f) curved multiplanar reformatted cardiac computed tomographic image showing the presence of a concomitant aortopathy. Ao: aorta; LAD: left anterior descending coronary artery; LV: left ventricle; MPA: main pulmonary artery; RVOT: right ventricular outflow tract.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 28-year-old man presented with a five-hour history of central chest pain and dyspnea. His 12-lead electrocardiogram demonstrated biphasic T waves in leads V1–V4, and T-wave inversion in lead AVL (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>). He was accordingly treated for acute coronary syndrome and referred for coronary computed tomographic angiography (CTA), which showed unobstructed coronary arteries but also an additional vessel that represented a coronary artery fistula (CAF) (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>a–d). In addition there was a bicuspid aortic valve (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>e), concomitant aortopathy (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>f) and a dilated pulmonary artery. The patient underwent surgical ligation of the CAF and was discharged five days later following an uneventful recovery.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Coronary artery fistulae are usually congenital in origin and account for approximately 0.2–0.4% of all congenital cardiac abnormalities.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Although commonly asymptomatic, as the fistula progressively enlarges patients may present late in life with dyspnea, fatigue, stroke and endocarditis. Myocardial ischemia may also occur as a result of coronary steal, whereby coronary flow bypasses the myocardial capillary bed in preference for the low-pressure system of the fistula. CAFs in asymptomatic individuals should undergo careful periodic evaluation. In symptomatic individuals, surgical ligation and transcatheter embolization have been shown to be effective therapies.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The current case firstly demonstrates a rare cause of acute coronary syndrome precipitated by a CAF. Secondly it shows the value of coronary CTA in delineating a CAF and in detecting additional congenital abnormalities. Finally it raises the proposition that CAF may be a coronary anomaly associated with bicuspid aortic valve.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical disclosures</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of human and animal subjects</span><p id="par0015" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Confidentiality of data</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document.</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:3 [ "identificador" => "sec0005" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Right to privacy and informed consent" ] ] ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-04-24" "fechaAceptado" => "2014-05-04" "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1773 "Ancho" => 3330 "Tamanyo" => 1310591 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">12-lead electrocardiogram showing T-wave inversion in leads AVL and V1–V4.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 3480 "Ancho" => 2334 "Tamanyo" => 688212 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(a–c) Three-dimensional volume rendered cardiac computed tomography images showing the relationship of the coronary artery fistula (arrow) to the right ventricular outflow tract, aorta and main pulmonary artery in anterior (a), anterolateral (b) and lateral (c) planes; (d) curved multiplanar reformatted cardiac computed tomographic image showing the course of the coronary artery fistula anterior to the right ventricular outflow tract; (e) multiplanar reformatted cardiac computed tomographic image showing the presence of a non-calcified bicuspid aortic valve; (f) curved multiplanar reformatted cardiac computed tomographic image showing the presence of a concomitant aortopathy. Ao: aorta; LAD: left anterior descending coronary artery; LV: left ventricle; MPA: main pulmonary artery; RVOT: right ventricular outflow tract.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:2 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Another cause of chest pain: coronary artery-pulmonary artery fistulae" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "N. Yener" 1 => "A. Yener" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Int J Angiol" "fecha" => "2001" "volumen" => "10" "paginaInicial" => "85" "paginaFinal" => "87" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of coronary artery fistulae – patient selection and results of transcatheter closure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "L.R. Armsby" 1 => "J.F. Keane" 2 => "M.C. Sherwood" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2002" "volumen" => "39" "paginaInicial" => "1026" "paginaFinal" => "1032" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11897446" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003300000011/v1_201412120159/S2174204914002724/v1_201412120159/en/main.assets" "Apartado" => array:4 [ "identificador" => "9915" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in cardiology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003300000011/v1_201412120159/S2174204914002724/v1_201412120159/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204914002724?idApp=UINPBA00004E" ]
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| 2018 September | 15 | 8 | 23 |
| 2018 August | 28 | 3 | 31 |
| 2018 July | 10 | 7 | 17 |
| 2018 June | 28 | 2 | 30 |
| 2018 May | 37 | 13 | 50 |
| 2018 April | 45 | 2 | 47 |
| 2018 March | 73 | 10 | 83 |
| 2018 February | 25 | 4 | 29 |
| 2018 January | 32 | 3 | 35 |
| 2017 December | 33 | 5 | 38 |
| 2017 November | 16 | 5 | 21 |
| 2017 October | 21 | 8 | 29 |
| 2017 September | 25 | 13 | 38 |
| 2017 August | 31 | 10 | 41 |
| 2017 July | 19 | 14 | 33 |
| 2017 June | 32 | 9 | 41 |
| 2017 May | 30 | 6 | 36 |
| 2017 April | 12 | 1 | 13 |
| 2017 March | 31 | 6 | 37 |
| 2017 February | 47 | 1 | 48 |
| 2017 January | 16 | 2 | 18 |
| 2016 December | 41 | 9 | 50 |
| 2016 November | 17 | 4 | 21 |
| 2016 October | 23 | 3 | 26 |
| 2016 September | 22 | 4 | 26 |
| 2016 August | 1 | 2 | 3 |
| 2016 July | 10 | 3 | 13 |
| 2016 June | 15 | 2 | 17 |
| 2016 May | 10 | 3 | 13 |
| 2016 April | 38 | 9 | 47 |
| 2016 March | 28 | 11 | 39 |
| 2016 February | 32 | 18 | 50 |
| 2016 January | 31 | 12 | 43 |
| 2015 December | 21 | 13 | 34 |
| 2015 November | 23 | 13 | 36 |
| 2015 October | 28 | 15 | 43 |
| 2015 September | 28 | 13 | 41 |
| 2015 August | 18 | 5 | 23 |
| 2015 July | 23 | 6 | 29 |
| 2015 June | 11 | 0 | 11 |
| 2015 May | 21 | 8 | 29 |
| 2015 April | 13 | 13 | 26 |
| 2015 March | 17 | 10 | 27 |
| 2015 February | 17 | 5 | 22 |
| 2015 January | 36 | 16 | 52 |
| 2014 December | 21 | 6 | 27 |
Show all
