Coronary artery fistula: Review of 54 cases from single center experience

Background: Demographic and clinical characteristics and angiographic findings of Turkish patients with coronary artery fistula have been investigated in this study and diagnostic tests and treatment methods used in these patients have also been evaluated in detail. Methods: We have examined the cardiac catheterization laboratory database retrospectively between March 2006 and July 2010. Among 49,567 patients, we have noted 60 patients diagnosed as coronary artery fistula. After coronary angiographic images were evaluated by two invasive cardiologists, 54 patients who had clear evidence of vessel of origin and drainage were included in the study. Results: A total of 54 (0.1%) patients with coronary artery fistula were noted. Mean age was 56.7 ± 10.7 years; 42 out of 54 patients had accompanying cardiac disorders. Patients’ complaints were directly associated with the presence of the fistula. Chest pain was the admission symptom in all of the patients with isolated coronary artery fistula. Six patients had coexistent congenital anomalies. Myocardial infarction with ST segment elevation occurred in 11 of the patients. In contrast to the previous reports, the most common artery of origin of the fistula was left anterior descending artery (50.8%) and pulmonary artery was found to be the most frequent region of the fistula drainage by 53.7%. Conclusions: Our findings suggest that large fistulas originating from the proximal segments of coronary arteries may increase the likelihood of atherosclerosis and myocardial infarction even in asymptomatic patients with no evidence of ischemia in noninvasive tests and no dilatation of cardiac chambers, and should therefore be closed

The effects of dialysis-type on left ventricular function in non-diabetic end-stage renal disease patients

WOS: 000391781800011PubMed: 27920459Objective In this study we aimed to investigate a possible difference in left ventricular function in patients undergoing peritoneal dialysis (PD) and haemodialysis (HD) using 2D echocardiography. Methods A total of 84 patients were recruited in the study. Both PD and HD groups consisted of 42 end-stage renal disease patients. Patients with left ventricular ejection fraction (EF) <50%, diabetes mellitus and coronary artery disease were excluded. Baseline characteristics and conventional tissue Doppler echocardiography parameters were recorded. Left ventricular longitudinal (Ls), circumferential (Cs) and radial strain (R) along with strain rate were also recorded in the speckle-tracking echocardiography. These values were compared between the two groups. Results No significant difference was observed between PD and HD patients, in terms of mean time from diagnosis of chronic kidney disease to initiation of the study, mean time from first dialysis to initiation of the study, left ventricular EF, age, sex and heart rate. Left ventricular hypertrophy was also more frequent in HD group and the patients had a higher left ventricular mass index. Left ventricular global Ls, LSRs, LSRe, LSRa and global Rs, RSRs, RSRe, RSRa were detected to be lower in HD patients. Conclusions Longitudinal and radial left ventricular mechanics were found to be better preserved in patients undergoing peritoneal dialysis when compared to haemodialysis patients. Consequently, it can be concluded that peritoneal dialysis provides better protection on left ventricular systolic function compared to haemodialysis