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CORONARY STEAL SYNDROME FROM A GIANT RCA WITH CORONARY SINUS FISTULA
1225 JACC April 5, 2016 Volume 67, Issue 13
FIT Clinical Decision Making CORONARY STEAL SYNDROME FROM A GIANT RCA WITH CORONARY SINUS FISTULA Poster Contributions Poster Area, South Hall A1 Sunday, April 03, 2016, 3:45 p.m.-4:30 p.m. Session Title: FIT Clinical Decision Making: Non-Invasive Imaging and Valvular Heart Disease Abstract Category: Non Invasive Imaging Presentation Number: 1232-321 Authors: Deephak Swaminath, Thomas Jordan, Roshni Narayanan, Brian Donelan, Mark Iler, Marc Penn, Summa Health System, Akron, OH, USA Case: A 69 year old female was referred for a cardiac murmur that was detected on a routine health screening. PMH significant for SLE, HTN, and asthma. She endorsed many years of mild dyspnea on exertion which she attributed to a childhood diagnosis of asthma. She also endorsed many years of rare paroxysms of chest discomfort associated with exertion and relieved with rest. Physical examination notable for grade II/VI systolic murmur loudest at 3rd ICS.
Decision Making: Echocardiogram showed several abnormal vascular structures were noted in the left inferior AV groove, adjacent to and communicating with the coronary sinus.LHC showed no coronary stenosis and a markedly abnormal giant RCA with an apparent fistula to the coronary sinus. Coronary CTA showed a giant, tortuous, dominant RCA with a caliber of approximately 10 mm thoughout most of its course. Aneurysmal segments were present in the proximal RCA, superior right AV groove (2.4 cm) and distal RCA, inferior left AV groove (1.8 cm) finally draining into the right atrium. Inspite of abnormal RCA and fistula the patient had minimal symptom. The risk outweighed the benefit of a surgical intervention at this time. The plan is to follow up the patient clinically and by echocardiogram. Conclusions: This case demonstrates the importance of multimodality imaging for diagnosis and treatment. Also this case demonstrates the coronary steal syndrome. The dilated RCA and gaint aneursym steals blood from the left coronary system leading to symptoms like chest pain and dyspnea.
FIT Clinical Decision Making CORONARY STEAL SYNDROME FROM A GIANT RCA WITH CORONARY SINUS FISTULA Poster Contributions Poster Area, South Hall A1 Sunday, April 03, 2016, 3:45 p.m.-4:30 p.m. Session Title: FIT Clinical Decision Making: Non-Invasive Imaging and Valvular Heart Disease Abstract Category: Non Invasive Imaging Presentation Number: 1232-321 Authors: Deephak Swaminath, Thomas Jordan, Roshni Narayanan, Brian Donelan, Mark Iler, Marc Penn, Summa Health System, Akron, OH, USA Case: A 69 year old female was referred for a cardiac murmur that was detected on a routine health screening. PMH significant for SLE, HTN, and asthma. She endorsed many years of mild dyspnea on exertion which she attributed to a childhood diagnosis of asthma. She also endorsed many years of rare paroxysms of chest discomfort associated with exertion and relieved with rest. Physical examination notable for grade II/VI systolic murmur loudest at 3rd ICS.
Decision Making: Echocardiogram showed several abnormal vascular structures were noted in the left inferior AV groove, adjacent to and communicating with the coronary sinus.LHC showed no coronary stenosis and a markedly abnormal giant RCA with an apparent fistula to the coronary sinus. Coronary CTA showed a giant, tortuous, dominant RCA with a caliber of approximately 10 mm thoughout most of its course. Aneurysmal segments were present in the proximal RCA, superior right AV groove (2.4 cm) and distal RCA, inferior left AV groove (1.8 cm) finally draining into the right atrium. Inspite of abnormal RCA and fistula the patient had minimal symptom. The risk outweighed the benefit of a surgical intervention at this time. The plan is to follow up the patient clinically and by echocardiogram. Conclusions: This case demonstrates the importance of multimodality imaging for diagnosis and treatment. Also this case demonstrates the coronary steal syndrome. The dilated RCA and gaint aneursym steals blood from the left coronary system leading to symptoms like chest pain and dyspnea.