A 51-year-old male, admitted with an inferior ST elevation acute myocardial infarction, revealed two coronary - pulmonary fistulae, originating from the right coronary and the circumflex artery, besides significant three-vessel disease. Occlusion of the middle segment of the right coronary artery was treated by primary percutaneous coronary intervention. Afterwards, noninvasive coronariography by computed tomography and myocardial perfusion scintigraphy were crucial for a therapeutic decision. The right coronary artery fistula was percutaneously closed. Congenital fistulae of the coronary arteries are rare, being circumflex artery fistulae and simultaneous involvement of both coronary arteries is an even rarer feature.
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We report a case of successful percutaneous intervention to the left main stem in a patient with high grade myelodysplastic syndrome and severe thrombocytopenia (platelet count 33 x 109/L). Before the procedure the patient received a platelet transfusion and a standard 300 mg loading dose of clopidogrel. Dual antiplatelet therapy was continued for one month with no bleeding complications.
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Coronary arteries-to-cavity fistulae are rare and most often congenital in origin. Left coronary artery-left ventricle fistulae are even more uncommon. We present the case of a 70-year-old asymptomatic patient with abnormal ECG referred to our cardiology department for evaluation. Transthoracic Doppler echocardiography raised the suspicion of a coronary artery - left ventricle fistula, which was confirmed on coronary angiography by revealing multiple left coronary artery - left ventricle fistulae. Because the patient was asymptomatic, with a negative exercise test and no significant shunt was detected conservative treatment was recommended.
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We report a case of a 60-year-old male who was admitted to the emergency department with a two hour history of chest pain. He had taken cocaine within eight hours of admission. ECG showed anterior ST segment elevations. Angiography revealed a spasm of the proximal LAD with accompanying large thrombus. Since the flow to the distal part of the LAD was preserved, no invasive treatment was performed. The scheduled control angiography showed a complete resolution of the thrombus and slight residual stenosis in the ostium of the LAD. This example illustrates the possible mechanisms involved in myocardial infarction after cocaine use.
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