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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Coronary to pulmonary fistula is an uncommon cardiac anomaly seen in 0&#46;05-0&#46;25&#37; of patients undergoing diagnostic coronary angiography&#46; Coronary artery fistulae are usually asymptomatic but larger and multiple fistulae can lead to ischemia&#44; congestive heart failure&#44; myocardial infarction and pulmonary hypertension&#46; Although usually congenital&#44; they may be acquired&#46; They most frequently arise from the right coronary artery system &#40;55&#37;&#41;&#44; less often from the left coronary artery system &#40;35&#37;&#41;&#44; and rarely from both coronary arteries &#40;5&#37;&#41;&#46; The most common locations into which they drain are&#44; in decreasing order&#44; the right ventricle&#44; right atrium&#44; pulmonary artery&#44; coronary sinus&#44; left atrium&#44; left ventricle&#44; and superior vena cava&#46; Although most fistulae are single&#44; multiple fistulae have been reported&#46; The most common type of coronary artery fistula in one study was to the pulmonary artery&#44; but multiple fistulae of all three coronary arteries to the pulmonary artery and concomitant anomalous coronary origin have not been previously reported&#46; We present a rare case of a symptomatic patient with congenital multiple coronary arteriovenous fistulae originating from the left anterior descending artery &#40;LAD&#41;&#44; left circumflex artery &#40;LCX&#41; and right coronary artery &#40;RCA&#41; draining into the pulmonary artery&#44; and concomitant anomalous coronary origin&#44; with the LCX arising from the right coronary system&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 65-year-old man was admitted with severe dyspnea and typical chest pain&#46; Clinical examination revealed a grade 2 continuous murmur in the mesocardiac area&#46; His medical history included hypertension and dyslipidemia as risk factors for coronary artery disease&#46; A standard 12-lead electrocardiogram revealed no significant alterations&#46; Transthoracic echocardiography demonstrated impaired left ventricular relaxation&#44; left ventricular ejection fraction of 65&#37;&#44; no significant valvular disease and pulmonary artery systolic pressure of 45 mmHg&#46; Subsequently&#44; coronary angiography showed multiple fistulae of all three coronary arteries&#44; which drained into the pulmonary artery &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A and B&#41; and concomitant coronary anomaly with the LCX originating from the right coronary system &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>A&#41;&#46; Furthermore&#44; the RCA was the origin of fistulae in two different locations&#44; at mid level and the conus branch &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>B&#41;&#46; We recommended percutaneous coil embolization and a vascular plug for the fistulae but the patient refused interventional treatment&#44; so he was given optimal medical treatment &#40;beta-blockers and anti-hypertensive and lipid-lowering medication&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><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&#46;</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&#46;</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&#46; The corresponding author is in possession of this document&#46;</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&#46;</p></span></span>"
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Image in Cardiology
Multiple fistulae of all three coronary arteries draining into the pulmonary artery and concomitant coronary anomaly
Fístulas múltiplas nas três artérias coronárias drenando para a artéria pulmonar com anomalia coronária concomitante
Mehmet Burak Özena, Tahir Durmazb, Hüseyin Ayhanb,
Corresponding author
huseyinayhan44@yahoo.com

Corresponding author.
, Mehmet Erdoğana
a Ankara Ataturk Education and Research Hospital, Department of Cardiology, Ankara, Turkey
b Yıldırım Beyazıt University, Faculty of Medicine, Department of Cardiology, Ankara, Turkey
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Coronary to pulmonary fistula is an uncommon cardiac anomaly seen in 0&#46;05-0&#46;25&#37; of patients undergoing diagnostic coronary angiography&#46; Coronary artery fistulae are usually asymptomatic but larger and multiple fistulae can lead to ischemia&#44; congestive heart failure&#44; myocardial infarction and pulmonary hypertension&#46; Although usually congenital&#44; they may be acquired&#46; They most frequently arise from the right coronary artery system &#40;55&#37;&#41;&#44; less often from the left coronary artery system &#40;35&#37;&#41;&#44; and rarely from both coronary arteries &#40;5&#37;&#41;&#46; The most common locations into which they drain are&#44; in decreasing order&#44; the right ventricle&#44; right atrium&#44; pulmonary artery&#44; coronary sinus&#44; left atrium&#44; left ventricle&#44; and superior vena cava&#46; Although most fistulae are single&#44; multiple fistulae have been reported&#46; The most common type of coronary artery fistula in one study was to the pulmonary artery&#44; but multiple fistulae of all three coronary arteries to the pulmonary artery and concomitant anomalous coronary origin have not been previously reported&#46; We present a rare case of a symptomatic patient with congenital multiple coronary arteriovenous fistulae originating from the left anterior descending artery &#40;LAD&#41;&#44; left circumflex artery &#40;LCX&#41; and right coronary artery &#40;RCA&#41; draining into the pulmonary artery&#44; and concomitant anomalous coronary origin&#44; with the LCX arising from the right coronary system&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 65-year-old man was admitted with severe dyspnea and typical chest pain&#46; Clinical examination revealed a grade 2 continuous murmur in the mesocardiac area&#46; His medical history included hypertension and dyslipidemia as risk factors for coronary artery disease&#46; A standard 12-lead electrocardiogram revealed no significant alterations&#46; Transthoracic echocardiography demonstrated impaired left ventricular relaxation&#44; left ventricular ejection fraction of 65&#37;&#44; no significant valvular disease and pulmonary artery systolic pressure of 45 mmHg&#46; Subsequently&#44; coronary angiography showed multiple fistulae of all three coronary arteries&#44; which drained into the pulmonary artery &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A and B&#41; and concomitant coronary anomaly with the LCX originating from the right coronary system &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>A&#41;&#46; Furthermore&#44; the RCA was the origin of fistulae in two different locations&#44; at mid level and the conus branch &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>B&#41;&#46; We recommended percutaneous coil embolization and a vascular plug for the fistulae but the patient refused interventional treatment&#44; so he was given optimal medical treatment &#40;beta-blockers and anti-hypertensive and lipid-lowering medication&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><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&#46;</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&#46;</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&#46; The corresponding author is in possession of this document&#46;</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&#46;</p></span></span>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Left coronary angiography demonstrating a coronary fistula from the left anterior descending coronary artery to the pulmonary artery&#59; &#40;B&#41; right coronary angiography demonstrating a coronary fistula from the right coronary artery to the pulmonary artery&#46;</p>"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Right coronary angiography demonstrating an anomalous origin of the left circumflex artery and coronary fistula to the pulmonary artery&#59; &#40;B&#41; right coronary angiography demonstrating coronary fistula from the conus branch to the pulmonary artery&#46;</p>"
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Article information
ISSN: 21742049
Original language: English
DOI:10.1016/j.repce.2017.02.009
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