J Korean Med Sci.  2006 Dec;21(6):1111-1114. 10.3346/jkms.2006.21.6.1111.

Spontaneous Closure of Iatrogenic Coronary Artery Fistula to Left Ventricle After Septal Myectomy for Hypertrophic Obstructive Cardiomyopathy

• Choi YJ
• You CW
• Park MK
• Park JI
• Kwon SU
• Lee SC
• Lee HJ
• Park SW

• KMID: 1713129
• DOI: http://doi.org/10.3346/jkms.2006.21.6.1111

Abstract

Cases of iatrogenic coronary artery fistulas draining into the left ventricle after surgical myectomy for hypertrophic obstructive cardiomyopathy have been published as sporadic reports. However, its management scheme and prognosis are not clear because of the low incidence. A 46-yr-old woman was hospitalized for evaluation of chest pain and shortness of breath for 3 months. Transthoracic echocardiographic examination showed typical hypertrophic obstructive cardiomyopathy with a peak pressure gradient of 71 mmHg across the left ventricular outflow tract. The patient underwent surgical septal myectomy. Postoperative color Doppler imaging revealed a diastolic blood flow from the interventricular septal myocardium to the left ventricular cavity, i.e. iatrogenic coronary artery fistula to the left ventricle. Ten days later, the fistula closed spontaneously which was diagnosed by transthoracic echocardiography and confirmed by coronary angiography.

Keyword

Cardiomyopathy, Hypertrophic; Vascular Fistula; Postoperative Complications

MeSH Terms

Vascular Fistula/diagnosis/*etiology
Middle Aged
*Iatrogenic Disease
Humans
Heart Ventricles/*abnormalities
Heart Septum/*surgery
Female
Coronary Vessel Anomalies/diagnosis/*etiology
Cardiovascular Surgical Procedures/*adverse effects
Cardiomyopathy, Hypertrophic/complications/*surgery

Figure

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  Fig. 1 A resting electrocardiogram shows left ventricular hypertrophy with an inverted T waves in the precordial leads.

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  Fig. 2 Chest radiography shows moderate cardiomegaly without pulmonary edema.

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  Fig. 3 Hypertrophied basal septal wall (A) was reduced in thickness after surgical septal myectomy (B). Arrowheads indicate the site of myectomy.

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  Fig. 4 In the parasternal long axis view, color Doppler examination shows the shunt flow from the septal perforators to the left ventricular cavity occurring during diastole at the myectomy site in the basal interventricular septum (A), and its peak velocity is approximately 3.0 m/sec during diastole on pulsed wave Doppler examination. It is consistent with a coronary artery to left ventricular fistula.

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