| Prevalence and clinical significance of acquired left coronary artery fistulas after surgical myectomy in patients with hypertrophic cardiomyopathy. | |
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MedLine Citation:
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PMID: 20471659 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: The relevance of iatrogenic left coronary artery fistulas complicating surgical myectomy in patients with hypertrophic cardiomyopathy is not known. We prospectively defined the echocardiographic features, prevalence, and clinical significance of left coronary artery fistulas in 40 consecutive patients with hypertrophic cardiomyopathy undergoing extended septal myectomy. METHODS: Echocardiographic analysis was performed preoperatively and 1 and 6 months after surgical intervention. Diagnosis of left coronary artery fistulas required evidence of diastolic flow draining from the left ventricular wall into the left ventricular cavity according to prespecified criteria. RESULTS: Left coronary artery fistulas were detected in 9 (23%) of the 40 study patients as a single occurrence in all except 1 patient, who had multiple fistulas. At 6 months, left coronary artery fistulas could still be detected in only 2 of the 9 patients. Of these, 1 patient remained asymptomatic but continued to show left coronary artery fistula persistence at 37 months postoperatively. The other, a woman with prior alcohol septal ablation, had progressive severe symptoms that required percutaneous closure of the fistula with a covered stent after angiographic identification of a large first septal branch fistula associated with distal left anterior descending coronary artery steal. CONCLUSIONS: In patients with hypertrophic cardiomyopathy, left coronary artery fistulas are common in the early period after surgical myectomy, although their echocardiographic prevalence is dependent on operator awareness. Most left coronary artery fistulas heal spontaneously. Occasionally, however, fistulas can persist and cause symptoms requiring therapeutic intervention. |
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Authors:
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Aurelio Sgalambro; Iacopo Olivotto; Alessandra Rossi; Stefano Nistri; Katia Baldini; Massimo Baldi; Pierluigi Stefano; David Antoniucci; Francesca Garbini; Franco Cecchi; Magdi H Yacoub |
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Publication Detail:
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Type: Journal Article Date: 2010-05-14 |
Journal Detail:
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Title: The Journal of thoracic and cardiovascular surgery Volume: 140 ISSN: 1097-685X ISO Abbreviation: J. Thorac. Cardiovasc. Surg. Publication Date: 2010 Nov |
Date Detail:
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Created Date: 2010-10-18 Completed Date: 2010-11-08 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0376343 Medline TA: J Thorac Cardiovasc Surg Country: United States |
Other Details:
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Languages: eng Pagination: 1046-52 Citation Subset: AIM; IM |
Copyright Information:
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Copyright © 2010 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved. |
Affiliation:
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Referral Center for Myocardial Diseases, Careggi University Hospital, Florence, Italy. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Cardiac Surgical Procedures / adverse effects* Cardiomyopathy, Hypertrophic / surgery* Coronary Artery Disease / epidemiology, etiology*, therapy, ultrasonography Echocardiography, Doppler, Color Female Heart Diseases / epidemiology, etiology*, therapy, ultrasonography Heart Ventricles / ultrasonography Humans Iatrogenic Disease* Male Middle Aged Prevalence Prospective Studies Remission, Spontaneous Time Factors Treatment Outcome Vascular Fistula / epidemiology, etiology*, therapy, ultrasonography |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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