Image in Cardiology
Bilateral aneurysmatic coronary artery-pulmonary artery trunk fistulae
Fístulas aneurismáticas bilaterais entre as artérias coronárias e tronco da artéria pulmonar
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array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1134 "Ancho" => 992 "Tamanyo" => 174356 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Intraoperative photographs following median sternotomy: (A) large aneurysm of the left ventricular inferior wall; (B) wall thrombus removed from ventricular aneurysm; (C) aneurysm neck closed with a Dacron<span class="elsevierStyleSup">®</span> patch.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Gustavo Lima da Silva, Catarina Carvalheiro, Pedro Cardoso, Ricardo Arruda, Ângelo Nobre, Ana G. 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Almeida, Paula Campos, Luís Parente Martins, Roberto Palma Reis" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Milan" "apellidos" => "Satendra" "email" => array:1 [ 0 => "milan.satendra@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Catarina" "apellidos" => "Sousa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Ana" "apellidos" => "G. Almeida" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Paula" "apellidos" => "Campos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "Luís" "apellidos" => "Parente Martins" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "Roberto" "apellidos" => "Palma Reis" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Serviço de Cardiologia, Centro Hospitalar Lisboa Norte, Lisboa, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Serviço de Radiologia, Centro Hospitalar Lisboa Norte, Lisboa, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Fístulas aneurismáticas bilaterais entre as artérias coronárias e tronco da artéria pulmonar" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1556 "Ancho" => 1952 "Tamanyo" => 375117 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A and B) Transthoracic echocardiogram and color Doppler showing tunnel-like communication (arrows). (C and D) Cross-sectional computed tomography image showing the courses of the fistulae (arrows). (E and F) Three-dimensional volume-rendered multislice multiplanar reconstruction computed tomography views showing the courses of the fistulae (arrows and asterisk).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 54-year-old asymptomatic woman presented to our echocardiography department for assessment of a continuous heart murmur. The transthoracic echocardiogram in parasternal short-axis view (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A) revealed a tunnel-like communication between the pulmonary artery trunk and the pericardial space (maximum width 8 mm). Color Doppler showed turbulent flow and pulsed wave Doppler showed typical continuous flow (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>B). No valvular abnormalities were noted. There was a normal balance between the right and left ventricle, with preserved global systolic function. The estimated shunt by Qp/Qs was 1.3:1.0. The cardiac computed tomography scan revealed a large coronary artery fistula (CAF) between the left descending coronary artery and pulmonary artery trunk and also an aneurysmatic, tortuous CAF between the right coronary artery and pulmonary artery trunk (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>C–F). A maximal exercise test was performed that excluded myocardial ischemia. She is currently asymptomatic and no cardiac events were noted in two-year follow-up.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">We present this case because bilateral coronary to pulmonary artery fistulae are a very rare entity. CAFs found to originate from both coronary arteries are rare and the pulmonary vasculature is the most uncommon site of termination.</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 the procedures followed were in accordance with the regulations of the relevant clinical research ethics committee and with those of the Code of Ethics of the World Medical Association (Declaration of Helsinki).</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:2 [ 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" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-12-01" "fechaAceptado" => "2015-01-02" "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1556 "Ancho" => 1952 "Tamanyo" => 375117 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A and B) Transthoracic echocardiogram and color Doppler showing tunnel-like communication (arrows). (C and D) Cross-sectional computed tomography image showing the courses of the fistulae (arrows). (E and F) Three-dimensional volume-rendered multislice multiplanar reconstruction computed tomography views showing the courses of the fistulae (arrows and asterisk).</p>" ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003400000078/v1_201508050210/S217420491500166X/v1_201508050210/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/21742049/0000003400000078/v1_201508050210/S217420491500166X/v1_201508050210/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217420491500166X?idApp=UINPBA00004E" ]
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