Document Detail

Iatrogenic coronary-to-right ventricle fistula: benign outcome irrespective of patency?
MedLine Citation:
PMID:  18509297     Owner:  NLM     Status:  MEDLINE    
Coronary perforation is an uncommon, but potentially lethal complication of percutaneous coronary interventions. Most perforations have proved to lead to intramyocardial or intrapericardial extravasation. However, perforation may also lead to direct coronary-to-right ventricle fistula, more commonly occurring in complex lesions and/or the use of atheroablative devices. To prevent this complication careful manipulation of the guidewire across the obstruction is mandatory, together with avoidance of oversized balloons and high-pressure inflations. The factors that determine the hemodynamic significance of the fistulas include size of the communication, resistance of the recipient chamber, and potential for development of myocardial ischemia. Accordingly a broad range of signs and symptoms may be referred. Despite iatrogenic fistulas are usually benign and asymptomatic, spontaneous closures are very rare. In most cases fistulas need to be treated by percutaneous or surgical closure, being the conservative management a debated option. In isolated cases serious complications have been described resulting from volume overload and distal myocardial flow impairment. We hereby describe two cases of coronary-to-right ventricle fistula occurred during percutaneous coronary intervention, highlighting full angiographic iconography and the issues involved in the management and follow-up of this iatrogenic complication.
M Anselmino; L Ravera; G Biondi-Zoccai; C Moretti; I Sheiban
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Minerva cardioangiologica     Volume:  56     ISSN:  0026-4725     ISO Abbreviation:  Minerva Cardioangiol     Publication Date:  2008 Jun 
Date Detail:
Created Date:  2008-05-29     Completed Date:  2008-09-25     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0400725     Medline TA:  Minerva Cardioangiol     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  365-9     Citation Subset:  IM    
Cardiology Unit, Department of Medicine, University of Turin, Turin, Italy.
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MeSH Terms
Angioplasty, Transluminal, Percutaneous Coronary / adverse effects*
Coronary Angiography
Coronary Disease / etiology*,  pathology
Fistula / etiology*,  ultrasonography
Heart Diseases / etiology*,  pathology
Heart Ventricles / pathology
Iatrogenic Disease
Postoperative Complications / etiology*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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