Evaluación de pacientes portadores de fístulas coronario-ventriculares múltiples

Ariel Durán; Virginia Michelis; Pablo Díaz; Mariela Lujambio; Fernando Kuster; Ricardo Lluberas; Carlos Romero

Authors

Ariel Durán Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Departamento de Cardiología, Profesor Adjunto
Virginia Michelis Cardióloga
Pablo Díaz Instituto de Cardiología Infantil del Uruguay, Cardiólogo Intervencionista
Mariela Lujambio Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Departamento de Cardiología, Profesora Adjunta
Fernando Kuster Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Departamento de Cardiología, Profesor Agregado
Ricardo Lluberas Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Departamento de Cardiología, Profesor Agregado
Carlos Romero Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Departamento de Cardiología, Profesor Director

Keywords:

ANOMALIES OF THE CORONARY VESSELS, ARTERIOVENOUS FISTULA, ANGINA PECTORIS

Abstract

We describe four women with angina pectoris and positive functional tests using cineangiocoronarygraphy, multiple coronary ventricular fistulas were found but no obstructive injuries were seen. Stress testing by bicycle ergometer was assessed by a modificated Bruce protocol. Three cases underwent a MIBI myocardial scintigraphy with progressive exercise test and the remainder underwent dipyridamole-thalium imaging. Multiple coronary ventricular fistulas is an alteration of coronary circulation that includes an abnormal communication between coronary arteries and a cardiac camera characterized by multiple fistulas of small caliber. They are also known as generalized myocardial microfistulas. Estimated prevalence is lower than 0.2%. Angina is the main symptom, coronary steal is supposed to be the physiopathologic mechanism, but cases with recorded ischemia are rare. We agree with the description appeared in international literature of patients with angor, positive functional tests and no obstructive coronary injuries, where multiple coronary ventricular fistulas are indicated as causing this symptomatology.

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