Korean Circ J.  2012 Oct;42(10):714-717. 10.4070/kcj.2012.42.10.714.

Severe Form of Persistent Thebesian Veins Presenting as Ischemic Heart Disease

• Jung Y
• Kim HJ
• Yoon CH

• KMID: 1826471
• DOI: http://doi.org/10.4070/kcj.2012.42.10.714

Abstract

Coronary artery fistula is a rare congenital anomaly. Most patients with this anomaly are asymptomatic, but some may develop heart failure, myocardial ischemia or arrhythmias. We report a case of a patient who presented with myocardial ischemia secondary to persistent Thebesian veins. Coronary angiography demonstrated a marked capillary blush draining into the left ventricular cavity through multiple microfistulae from the left anterior descending artery, left circumflex artery and right coronary artery. The patient was discharged without chest pain and was medically maintained with a beta-blocker and angiotensin converting enzyme inhibitor.

Keyword

Coronary vessel anomalies; Coronary angiography; Arteriovenous fistula; Myocardial ischemia

MeSH Terms

Arrhythmias, Cardiac
Arteries
Arteriovenous Fistula
Capillaries
Chest Pain
Coronary Angiography
Coronary Vessel Anomalies
Coronary Vessels
Fistula
Heart Failure
Humans
Myocardial Ischemia
Peptidyl-Dipeptidase A
Veins
Peptidyl-Dipeptidase A

Figure

• 

  Fig. 1 Twelve-lead ECG showing sinus rhythm with T-wave inversion in V 2-4 2 hours after admission (B) compared to initial ECG (A). ECG: electrocardiography.

• 

  Fig. 2 Coronary angiogram showing right coronary artery (A) and left main coronary artery (B). Arrows indicate multiple arteriosinousoidal fistulae filling with contrast agent on injection, visualizing the endocardial border (A and B).

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