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Extensively thrombosed ectatic circumflex coronary artery fistula presenting as acute coronary syndrome


Yousif, Nooraldaem; Shahin, Mohammady; Manka, Robert; Obeid, Slayman (2018). Extensively thrombosed ectatic circumflex coronary artery fistula presenting as acute coronary syndrome. Current Cardiology Reviews, 15:Epub ahead of print.

Abstract

BACKGROUND Coronary artery fistula (CAF) is an abnormal communication between the termination of a coronary artery or its branches and a cardiac chamber, a great vessel or other vascular structure. Symptomatic patients with large CAF should undergo surgical or percutanous closure of the fistula at the drainage site while still the debate on closing asymptomatic CAF and re-openening symptomatic occluded CAF is ongoing.
CASE SUMMARY We are reporting a 30-year-old male patient with no previous medical history presented as non-ST segment elevation myocardial Infarction. Coronary angiography showed an entirely thrombosed ectatic circumflex artery with a suspicion of thrombosed coronary arterial fistula. In view of ongoing ischemia in the setting of acute coronary syndrome; we tried to open percutaneously but all efforts were to no avail.
DISCUSSION In this case report, we are sharing our experience in management of this challenging case in view of the rarity of such peculiar clinical condition and the unfavourable presentation along with the lack of clear-cut Guideline and Consensus whether to/not to open such huge and immensely thrombosed symptomatic coronary artery fistula as well as the dilemma of choosing the best long-term medical treatment between antiplatelets vs anticoagulants in such young patient.

Abstract

BACKGROUND Coronary artery fistula (CAF) is an abnormal communication between the termination of a coronary artery or its branches and a cardiac chamber, a great vessel or other vascular structure. Symptomatic patients with large CAF should undergo surgical or percutanous closure of the fistula at the drainage site while still the debate on closing asymptomatic CAF and re-openening symptomatic occluded CAF is ongoing.
CASE SUMMARY We are reporting a 30-year-old male patient with no previous medical history presented as non-ST segment elevation myocardial Infarction. Coronary angiography showed an entirely thrombosed ectatic circumflex artery with a suspicion of thrombosed coronary arterial fistula. In view of ongoing ischemia in the setting of acute coronary syndrome; we tried to open percutaneously but all efforts were to no avail.
DISCUSSION In this case report, we are sharing our experience in management of this challenging case in view of the rarity of such peculiar clinical condition and the unfavourable presentation along with the lack of clear-cut Guideline and Consensus whether to/not to open such huge and immensely thrombosed symptomatic coronary artery fistula as well as the dilemma of choosing the best long-term medical treatment between antiplatelets vs anticoagulants in such young patient.

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Item Type:Journal Article, refereed, further contribution
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Cardiology
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:6 December 2018
Deposited On:01 Mar 2019 08:37
Last Modified:12 Mar 2019 02:07
Publisher:Bentham Science Publishers Ltd.
ISSN:1573-403X
OA Status:Closed
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.2174/1573403X15666181206120138
PubMed ID:30520380

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