Giant Aneurysm of a Coronary-Pulmonary Artery Fistula:A Rare Cause of a Diastolic Murmur

A coronary-pulmonary artery fistula with giant aneurysmal dilatation is an extremely rare clinical constellation.The natural course of this disease and the incidence of complications are unknown.Hence,optimal treatment,particularly in asymptomatic patients,is still a matter of debate.Here we report a case of a 71-year-old asymptomatic woman with a diastolic murmur.Comprehensive cardiovascular assessments including cardiac computed tomography and invasive coronary angiography revealed a coronary-pulmonary artery fi stula with giant aneurysmal dilatation.The patient was managed conservatively and has now been followed up for 5 years without any events.

Does Coronary Microvascular Spasm Exist?Objective Evidence from Intracoronary Doppler Flow Measurements During Acetylcholine Testing

A 43-year-old woman with recurrent atypical angina underwent invasive coronary angiography including intracoronary Doppler blood flow assessment and coronary spasm provocation testing.While obstructive epicardial disease could be ruled-out angiographically,the patient experienced reproduction of her angina symptoms after intracoronary administration of acetylcholine(100μg)during spasm provocation testing.Simultaneously,the ECG showed new-onset ST-segment depression in the absence of epicardial spasm.In addition,coronary fl ow velocity was signifi cantly reduced after acetylcholine compared to the baseline condition.Following intracoronary administration of nitroglycerine(200μg),the patient’s symptoms as well as the ECG changes and coronary flow reduction were reversed.Considering the ongoing challenges in appropriate evaluation of the pathophysiological mechanisms of coronary microvascular dysfunction,simultaneous intracoronary Doppler flow measurement during spasm testing–as shown in this case–may provide objective evidence for microvascular spasm in addition to the standardized diagnostic criteria,especially if they are ambiguous.

Persisting Angina after Successful Surgical Removal of a Large Coronary Artery Aneurysm Attached to the Proximal Portion of the Left Circumflex Artery:Role of Coronary Artery Spasm

Introduction and Patient Description,Assessment of patients with angina pectoris is a challenge for the clinical cardiologist.Myocardial ischemia and angina pectoris can be caused by various mechanisms,such as coronary atherosclerosis,vasospasm,or coronary microvascular dysfunction[1].Moreover,these mechanisms may overlap in a given patient,making it difficult to determine the cause of angina.We report here the case of a 57-year-old female patient with a history of angina pectoris that started 3 months previously.Her symptoms occurred predominantly at rest but also with effort.The patient was an active smoker who smoked about 15 cigarettes per day(~20 packyears).Moreover,she had hypertension treated with enalapril.Her LDL level was 75 mg/dl without any cholesterol-lowering therapy.She was sent for diagnostic coronary angiography for suspected stenosing coronary artery disease.

Occlusive Spasm of the Left Anterior Descending Artery and First Diagonal Branch After Implantation of Everolimus Eluting Stents Without Re-stenosis in a Female Patient with Resting Angina

Introduction Myocardial ischemia and angina pectoris can be caused by various mechanisms such as coronary atherosclerosis,vasospasm or coronary microvascular dysfunction[1].We here report a case of a56-year-old female patient with a history of previous percutaneous coronary interventions(PCI)who reported repetitive attacks of resting angina.Coronary risk factors included hypertension,hypercholesterolemia(LDL=97 mg/dL on atorvastatin),ex-smoker(ceased 2013),and a positive family history(fatal myocardial infarction in father aged52years and brother 59 years).