que se leu este artigo
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Coronary artery fistulae are usually asymptomatic but larger and multiple fistulae can lead to ischemia, congestive heart failure, myocardial infarction and pulmonary hypertension. Although usually congenital, they may be acquired. They most frequently arise from the right coronary artery system (55%), less often from the left coronary artery system (35%), and rarely from both coronary arteries (5%). The most common locations into which they drain are, in decreasing order, the right ventricle, right atrium, pulmonary artery, coronary sinus, left atrium, left ventricle, and superior vena cava. Although most fistulae are single, multiple fistulae have been reported. The most common type of coronary artery fistula in one study was to the pulmonary artery, but multiple fistulae of all three coronary arteries to the pulmonary artery and concomitant anomalous coronary origin have not been previously reported. We present a rare case of a symptomatic patient with congenital multiple coronary arteriovenous fistulae originating from the left anterior descending artery (LAD), left circumflex artery (LCX) and right coronary artery (RCA) draining into the pulmonary artery, and concomitant anomalous coronary origin, with the LCX arising from the right coronary system.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 65-year-old man was admitted with severe dyspnea and typical chest pain. Clinical examination revealed a grade 2 continuous murmur in the mesocardiac area. His medical history included hypertension and dyslipidemia as risk factors for coronary artery disease. A standard 12-lead electrocardiogram revealed no significant alterations. Transthoracic echocardiography demonstrated impaired left ventricular relaxation, left ventricular ejection fraction of 65%, no significant valvular disease and pulmonary artery systolic pressure of 45 mmHg. Subsequently, coronary angiography showed multiple fistulae of all three coronary arteries, which drained into the pulmonary artery (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A and B) and concomitant coronary anomaly with the LCX originating from the right coronary system (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>A). Furthermore, the RCA was the origin of fistulae in two different locations, at mid level and the conus branch (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>B). We recommended percutaneous coil embolization and a vascular plug for the fistulae but the patient refused interventional treatment, so he was given optimal medical treatment (beta-blockers and anti-hypertensive and lipid-lowering medication).</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.</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" => "2016-02-17" "fechaAceptado" => "2016-03-10" "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" => 842 "Ancho" => 1700 "Tamanyo" => 107623 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Left coronary angiography demonstrating a coronary fistula from the left anterior descending coronary artery to the pulmonary artery; (B) right coronary angiography demonstrating a coronary fistula from the right coronary artery to the pulmonary artery.</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" => 847 "Ancho" => 1700 "Tamanyo" => 94547 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A) Right coronary angiography demonstrating an anomalous origin of the left circumflex artery and coronary fistula to the pulmonary artery; (B) right coronary angiography demonstrating coronary fistula from the conus branch to the pulmonary artery.</p>" ] ] ] ] "idiomaDefecto" => "en" "url" => "/08702551/0000003600000002/v1_201702090011/S0870255116303936/v1_201702090011/en/main.assets" "Apartado" => array:4 [ "identificador" => "29264" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Imagens em Cardiologia" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/08702551/0000003600000002/v1_201702090011/S0870255116303936/v1_201702090011/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255116303936?idApp=UINPBA00004E" ]
Ano/Mês | Html | Total | |
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2022 Maio | 30 | 32 | 62 |
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2020 Dezembro | 22 | 11 | 33 |
2020 Novembro | 35 | 15 | 50 |
2020 Outubro | 37 | 8 | 45 |
2020 Setembro | 36 | 7 | 43 |
2020 Agosto | 30 | 11 | 41 |
2020 Julho | 54 | 14 | 68 |
2020 Junho | 43 | 13 | 56 |
2020 Maio | 37 | 3 | 40 |
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2020 Maro | 31 | 14 | 45 |
2020 Fevereiro | 124 | 12 | 136 |
2020 Janeiro | 37 | 3 | 40 |
2019 Dezembro | 50 | 7 | 57 |
2019 Novembro | 35 | 9 | 44 |
2019 Outubro | 36 | 7 | 43 |
2019 Setembro | 39 | 4 | 43 |
2019 Agosto | 36 | 8 | 44 |
2019 Julho | 30 | 13 | 43 |
2019 Junho | 26 | 6 | 32 |
2019 Maio | 28 | 6 | 34 |
2019 Abril | 38 | 19 | 57 |
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2019 Janeiro | 41 | 3 | 44 |
2018 Dezembro | 30 | 10 | 40 |
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2018 Outubro | 100 | 18 | 118 |
2018 Setembro | 40 | 10 | 50 |
2018 Agosto | 37 | 12 | 49 |
2018 Julho | 14 | 4 | 18 |
2018 Junho | 34 | 8 | 42 |
2018 Maio | 35 | 4 | 39 |
2018 Abril | 35 | 6 | 41 |
2018 Maro | 79 | 15 | 94 |
2018 Fevereiro | 23 | 5 | 28 |
2018 Janeiro | 59 | 9 | 68 |
2017 Dezembro | 53 | 9 | 62 |
2017 Novembro | 53 | 13 | 66 |
2017 Outubro | 28 | 11 | 39 |
2017 Setembro | 22 | 8 | 30 |
2017 Agosto | 39 | 12 | 51 |
2017 Julho | 28 | 6 | 34 |
2017 Junho | 27 | 14 | 41 |
2017 Maio | 51 | 17 | 68 |
2017 Abril | 25 | 8 | 33 |
2017 Maro | 26 | 11 | 37 |
2017 Fevereiro | 56 | 39 | 95 |
2017 Janeiro | 0 | 3 | 3 |