Image in Cardiology
Collateral damage from a coronary blush
Danos colaterais com blush coronário
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[ "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" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1772 "Ancho" => 3329 "Tamanyo" => 1329065 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">12-lead electrocardiogram showing T-wave inversion in leads AVL and V1–V4.</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" => 1772 "Ancho" => 3329 "Tamanyo" => 1329065 ] ] "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" => 2333 "Tamanyo" => 578337 ] ] "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" => "/08702551/0000003300000011/v1_201411200056/S0870255114002649/v1_201411200056/en/main.assets" "Apartado" => array:4 [ "identificador" => "357" "tipo" => "SECCION" "pt" => array:2 [ "titulo" => "Imagens em cardiologia" "idiomaDefecto" => true ] "idiomaDefecto" => "pt" ] "PDF" => "https://static.elsevier.es/multimedia/08702551/0000003300000011/v1_201411200056/S0870255114002649/v1_201411200056/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255114002649?idApp=UINPBA00004E" ]
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| 2019 Agosto | 27 | 11 | 38 |
| 2019 Julho | 24 | 10 | 34 |
| 2019 Junho | 29 | 3 | 32 |
| 2019 Maio | 37 | 10 | 47 |
| 2019 Abril | 24 | 11 | 35 |
| 2019 Maro | 70 | 12 | 82 |
| 2019 Fevereiro | 78 | 14 | 92 |
| 2019 Janeiro | 61 | 4 | 65 |
| 2018 Dezembro | 104 | 14 | 118 |
| 2018 Novembro | 58 | 9 | 67 |
| 2018 Outubro | 123 | 16 | 139 |
| 2018 Setembro | 27 | 9 | 36 |
| 2018 Agosto | 31 | 10 | 41 |
| 2018 Julho | 20 | 5 | 25 |
| 2018 Junho | 35 | 6 | 41 |
| 2018 Maio | 40 | 8 | 48 |
| 2018 Abril | 44 | 2 | 46 |
| 2018 Maro | 52 | 8 | 60 |
| 2018 Fevereiro | 29 | 3 | 32 |
| 2018 Janeiro | 34 | 5 | 39 |
| 2017 Dezembro | 52 | 16 | 68 |
| 2017 Novembro | 29 | 10 | 39 |
| 2017 Outubro | 21 | 9 | 30 |
| 2017 Setembro | 26 | 7 | 33 |
| 2017 Agosto | 41 | 14 | 55 |
| 2017 Julho | 28 | 12 | 40 |
| 2017 Junho | 40 | 10 | 50 |
| 2017 Maio | 32 | 9 | 41 |
| 2017 Abril | 26 | 5 | 31 |
| 2017 Maro | 23 | 4 | 27 |
| 2017 Fevereiro | 23 | 3 | 26 |
| 2017 Janeiro | 21 | 7 | 28 |
| 2016 Dezembro | 26 | 10 | 36 |
| 2016 Novembro | 11 | 3 | 14 |
| 2016 Outubro | 16 | 14 | 30 |
| 2016 Setembro | 17 | 4 | 21 |
| 2016 Agosto | 10 | 1 | 11 |
| 2016 Julho | 7 | 3 | 10 |
| 2016 Maio | 16 | 8 | 24 |
| 2016 Abril | 22 | 3 | 25 |
| 2016 Maro | 25 | 18 | 43 |
| 2016 Fevereiro | 34 | 26 | 60 |
| 2016 Janeiro | 39 | 13 | 52 |
| 2015 Dezembro | 29 | 13 | 42 |
| 2015 Novembro | 24 | 17 | 41 |
| 2015 Outubro | 25 | 16 | 41 |
| 2015 Setembro | 27 | 13 | 40 |
| 2015 Agosto | 29 | 9 | 38 |
| 2015 Julho | 24 | 5 | 29 |
| 2015 Junho | 19 | 4 | 23 |
| 2015 Maio | 33 | 4 | 37 |
| 2015 Abril | 24 | 8 | 32 |
| 2015 Maro | 25 | 12 | 37 |
| 2015 Fevereiro | 25 | 11 | 36 |
| 2015 Janeiro | 24 | 21 | 45 |
| 2014 Dezembro | 86 | 59 | 145 |
| 2014 Novembro | 31 | 22 | 53 |
Mostrar tudo
