AIM To assess the functionality of congenital coronary artery fistulas(CAFs) using adenosine stress ^(13)N-ammonia positron emission tomography computed tomography(PET-CT).METHODS Congenital CAFs were incidentally det...AIM To assess the functionality of congenital coronary artery fistulas(CAFs) using adenosine stress ^(13)N-ammonia positron emission tomography computed tomography(PET-CT).METHODS Congenital CAFs were incidentally detected during coronary angiography(CAG) procedures in 11 adult patients(six males and five females) with a mean age of 64.3 years(range 41-81). Patients were collected from three institutes in the Netherlands. The characteristics of the fistulas(origin, pathway and termination), multiplicity of the origins and pathways of the fistulous vessels were assessed by CAG. Five patients underwent adenosine pharmacologic stress ^(13)N-ammonia PET-CT to assess myocardial perfusion and the functional behavior of the fistula. RESULTS Eleven patients with 12 CAFs, 10 unilateral and one bilateral, originating from the left anterior descending coronary artery(n = 8), right coronary artery(n = 2) and circumflex(n = 2). All fistulas were of the vascular type, terminating into either the pulmonary artery(n = 11) or coronary sinus(n = 1). The CAG delineated the characteristics of the fistula(origin, pathway and termination). Multiplicity of the origins and pathways of the fistulous vessels were common in most fistulas(8/12, 67% and 9/12, 75%, respectively). Multiplicity was common among the different fistula components(23/36, 64%). Adenosine pharmacologic stress ^(13)N-ammonia PET-CT revealed normal myocardial perfusion and ejection fraction in all but one patient, who showed a reduced ejection fraction.CONCLUSION PET-CT may be helpful for assessing the functional status of congenital CAFs in selected patients regarding clinical decision-making. Studies with a larger patient series are warranted.展开更多
BACKGROUND Primary aorto-enteric fistula(PAEF)is a rare condition,traditionally treated in the acute,bleeding phase with open surgery or endovascular repair.However,these approaches have high morbidity and mortality,i...BACKGROUND Primary aorto-enteric fistula(PAEF)is a rare condition,traditionally treated in the acute,bleeding phase with open surgery or endovascular repair.However,these approaches have high morbidity and mortality,indicating a need for new methods.With advances in endoscopic techniques and equipment,haemoclipping of fistulas has now become feasible.Therefore,we present a systematic review of the English literature and a rare case of a PAEF successfully treated by endoscopic haemoclipping.CASE SUMMARY A 74-year-old man with an abdominal aortic aneurysm presented with symptoms of haemorrhagic shock and bloody stools.An oesophago-gastro-duodenoscopy was performed with haemoclipping of a suspected PAEF in the third part of the duodenum.Afterward,a computed tomography-angiography showed a contrast filled protrusion from the abdominal aortic aneurysm.Based on the clinical presentation and the combined endoscopic and radiographic findings,we argue that this is a case of a PAEF.CONCLUSION Endoscopic therapy appears capable of achieving haemodynamic stabilisation in patients with bleeding PAEF,serving as a bridge to final therapy.展开更多
Giant coronary artery aneurysms and coronary artery fistulae are uncommon pathologies. We present the case of an elderly woman who was referred to cardiology for investigation of possible ischaemic heart disease prior...Giant coronary artery aneurysms and coronary artery fistulae are uncommon pathologies. We present the case of an elderly woman who was referred to cardiology for investigation of possible ischaemic heart disease prior to orthopaedic surgery. The patient had developed chest pain in the setting of a septic total knee replacement associated with changes on electrocardiography. Coronary angiography revealed multiple coronary arteriovenous fistulae associated with giant coronary artery aneurysm causing steal syndrome in the setting of haemodynamic stress.展开更多
Dural arteriovenous fistula(DAVF) is a rare type of cerebral arteriovenous malformation. Common presenting symptoms are related to hemorrhage. However, rarely these patients may present with myelopathy. We present two...Dural arteriovenous fistula(DAVF) is a rare type of cerebral arteriovenous malformation. Common presenting symptoms are related to hemorrhage. However, rarely these patients may present with myelopathy. We present two cases of DAVF presenting as rapidly progressive myelopathy. Two treatment options are available: microsurgical interruption of the fistula and endovascular embolization. These treatment options of DAVFs have improved significantly in the last decade. The optimal treatment of DAVFs remains controversial, and there is an ongoing debate as to whether primary endovascular or primary microsurgical treatment is the optimal management for these lesions. However, despite treatment a high percentage of patients are still left with severe disability. The potential for functional ambulation in patients with DAVF is related to the time of intervention. This emphasizes the important of early diagnosis and early intervention in DAVF. The eventual outcome may depend on several factors, such as the duration of symptoms, the degree of disability before treatment, and the success of the initial procedure to close the fistula. The usage of magnetic resonance imaging and selective angiography has significantly improved the ability to characterize DAVFs, however, these lesions remain inefficiently diagnosed. If intervention is delayed even prolonged time in rehabilitation does not change the grave prognosis. This review outlines the presentation, classication and management of DAVF as well as discussing patient outcomes.展开更多
患者女,60岁,间断劳累后胸闷伴心悸、出汗、恶心1周,休息20~30 min后可缓解;7年前无明显诱因晕厥1次,未接受系统诊治;高血压病史2年,规律用药。查体:血压150/105 mm Hg,心肺查体未见明显异常。实验室检查及心电图未见明显异常。超声心动...患者女,60岁,间断劳累后胸闷伴心悸、出汗、恶心1周,休息20~30 min后可缓解;7年前无明显诱因晕厥1次,未接受系统诊治;高血压病史2年,规律用药。查体:血压150/105 mm Hg,心肺查体未见明显异常。实验室检查及心电图未见明显异常。超声心动图:左心室舒张末期容积118 ml,左心室舒张功能减低。展开更多
文摘AIM To assess the functionality of congenital coronary artery fistulas(CAFs) using adenosine stress ^(13)N-ammonia positron emission tomography computed tomography(PET-CT).METHODS Congenital CAFs were incidentally detected during coronary angiography(CAG) procedures in 11 adult patients(six males and five females) with a mean age of 64.3 years(range 41-81). Patients were collected from three institutes in the Netherlands. The characteristics of the fistulas(origin, pathway and termination), multiplicity of the origins and pathways of the fistulous vessels were assessed by CAG. Five patients underwent adenosine pharmacologic stress ^(13)N-ammonia PET-CT to assess myocardial perfusion and the functional behavior of the fistula. RESULTS Eleven patients with 12 CAFs, 10 unilateral and one bilateral, originating from the left anterior descending coronary artery(n = 8), right coronary artery(n = 2) and circumflex(n = 2). All fistulas were of the vascular type, terminating into either the pulmonary artery(n = 11) or coronary sinus(n = 1). The CAG delineated the characteristics of the fistula(origin, pathway and termination). Multiplicity of the origins and pathways of the fistulous vessels were common in most fistulas(8/12, 67% and 9/12, 75%, respectively). Multiplicity was common among the different fistula components(23/36, 64%). Adenosine pharmacologic stress ^(13)N-ammonia PET-CT revealed normal myocardial perfusion and ejection fraction in all but one patient, who showed a reduced ejection fraction.CONCLUSION PET-CT may be helpful for assessing the functional status of congenital CAFs in selected patients regarding clinical decision-making. Studies with a larger patient series are warranted.
文摘BACKGROUND Primary aorto-enteric fistula(PAEF)is a rare condition,traditionally treated in the acute,bleeding phase with open surgery or endovascular repair.However,these approaches have high morbidity and mortality,indicating a need for new methods.With advances in endoscopic techniques and equipment,haemoclipping of fistulas has now become feasible.Therefore,we present a systematic review of the English literature and a rare case of a PAEF successfully treated by endoscopic haemoclipping.CASE SUMMARY A 74-year-old man with an abdominal aortic aneurysm presented with symptoms of haemorrhagic shock and bloody stools.An oesophago-gastro-duodenoscopy was performed with haemoclipping of a suspected PAEF in the third part of the duodenum.Afterward,a computed tomography-angiography showed a contrast filled protrusion from the abdominal aortic aneurysm.Based on the clinical presentation and the combined endoscopic and radiographic findings,we argue that this is a case of a PAEF.CONCLUSION Endoscopic therapy appears capable of achieving haemodynamic stabilisation in patients with bleeding PAEF,serving as a bridge to final therapy.
文摘Giant coronary artery aneurysms and coronary artery fistulae are uncommon pathologies. We present the case of an elderly woman who was referred to cardiology for investigation of possible ischaemic heart disease prior to orthopaedic surgery. The patient had developed chest pain in the setting of a septic total knee replacement associated with changes on electrocardiography. Coronary angiography revealed multiple coronary arteriovenous fistulae associated with giant coronary artery aneurysm causing steal syndrome in the setting of haemodynamic stress.
文摘Dural arteriovenous fistula(DAVF) is a rare type of cerebral arteriovenous malformation. Common presenting symptoms are related to hemorrhage. However, rarely these patients may present with myelopathy. We present two cases of DAVF presenting as rapidly progressive myelopathy. Two treatment options are available: microsurgical interruption of the fistula and endovascular embolization. These treatment options of DAVFs have improved significantly in the last decade. The optimal treatment of DAVFs remains controversial, and there is an ongoing debate as to whether primary endovascular or primary microsurgical treatment is the optimal management for these lesions. However, despite treatment a high percentage of patients are still left with severe disability. The potential for functional ambulation in patients with DAVF is related to the time of intervention. This emphasizes the important of early diagnosis and early intervention in DAVF. The eventual outcome may depend on several factors, such as the duration of symptoms, the degree of disability before treatment, and the success of the initial procedure to close the fistula. The usage of magnetic resonance imaging and selective angiography has significantly improved the ability to characterize DAVFs, however, these lesions remain inefficiently diagnosed. If intervention is delayed even prolonged time in rehabilitation does not change the grave prognosis. This review outlines the presentation, classication and management of DAVF as well as discussing patient outcomes.
文摘患者女,60岁,间断劳累后胸闷伴心悸、出汗、恶心1周,休息20~30 min后可缓解;7年前无明显诱因晕厥1次,未接受系统诊治;高血压病史2年,规律用药。查体:血压150/105 mm Hg,心肺查体未见明显异常。实验室检查及心电图未见明显异常。超声心动图:左心室舒张末期容积118 ml,左心室舒张功能减低。
