Hostname: page-component-848d4c4894-sjtt6 Total loading time: 0 Render date: 2024-06-22T06:11:39.407Z Has data issue: false hasContentIssue false
  • English
  • Français

Acquired and progressive coronary arterial fistulae in patients with single-ventricle physiology and treated with pulmonary vasodilators

Part of: Functionally Univentricular Heart

Published online by Cambridge University Press:  22 March 2021

Kanta Kishi Open the ORCID record for Kanta Kishi [Opens in a new window] ,
Hiroshi Katayama ,
Shintaro Nemoto ,
Noriyasu Ozaki ,
Yutaka Odanaka ,
Atsuko Ashida ,
Hayato Konishi  and
Akira Ashida
Kanta Kishi*
Affiliation:
Department of Pediatrics, Osaka Medical College, Takatsuki, Osaka, Japan
Hiroshi Katayama
Affiliation:
Department of Pediatrics, Takatsuki Red Cross Hospital, Takatsuki, Osaka, Japan
Shintaro Nemoto
Affiliation:
Department of Pediatric Thoracic and Cardiovascular Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
Noriyasu Ozaki
Affiliation:
Department of Pediatrics, Osaka Medical College, Takatsuki, Osaka, Japan
Yutaka Odanaka
Affiliation:
Department of Pediatrics, Osaka Medical College, Takatsuki, Osaka, Japan
Atsuko Ashida
Affiliation:
Department of Pediatrics, Osaka Medical College, Takatsuki, Osaka, Japan
Hayato Konishi
Affiliation:
Department of Pediatric Thoracic and Cardiovascular Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
Akira Ashida
Affiliation:
Department of Pediatrics, Osaka Medical College, Takatsuki, Osaka, Japan
*
Author for correspondence: K. Kishi, MD, PhD, Department of Pediatrics, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka569-8686, Japan. Tel: +81 72 683 1221; Fax: +81 72 684 5798. E-mail: ped094@osaka-med.ac.jp
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Cardiac dysfunction, arrhythmia, and hepatic fibrosis are well-known complications after right heart bypass surgery in patients with single-ventricle physiology. However, little is known about coronary arterial fistulae, and only a few reports have been published. This study aimed to elucidate the clinical characteristics of these rare coronary arterial fistulae that developed as complications in cases of single-ventricle physiology after right heart bypass surgery.

Methods:

We retrospectively investigated the clinical features and courses of patients who developed acquired and progressive coronary arterial fistulae after right heart bypass surgery in our hospital.

Results:

We identified three cases of coronary arterial fistulae out of 21 patients who underwent right heart bypass surgery. All three cases underwent cardiac catheterisation for post-operative evaluation and were administered pulmonary vasodilators of phosphodiesterase type V inhibitors, antiplatelet, anticoagulation, and diuretics. Moreover, they had common clinical features such as right-dominant single ventricle and long-term exposure to chronic hypoxia. Serial angiograms revealed acquired and progressive coronary arterial fistulae. In addition, coronary arterial fistulae contributed to their symptoms of heart failure.

Conclusion:

Patients with chronic hypoxia and dominant right ventricle, who are treated with phosphodiesterase type V inhibitors, should be followed up after right heart bypass surgery to monitor the possible development of coronary arterial fistulae. Moreover, the indication for pulmonary vasodilators in single-ventricle physiology after right heart bypass surgery should be optimised to avoid adverse effects.

Keywords

CHDscoronary arterial fistulaepulmonary atresia with intact ventricular septumsingle-ventricle physiologypulmonary vasodilatorsheart failure
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 11 , November 2021 , pp. 1823 - 1828
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Pundi, KN, Johnson, JN, Dearani, JA, et al. 40-Year follow-up after the Fontan operation long-term outcomes of 1,052 patients. J Am Coll Cardiol 2015; 66: 1700–1710.CrossRefGoogle ScholarPubMed
Gewillig, M. The Fontan circulation. Heart 2005; 91: 839–846.CrossRefGoogle ScholarPubMed
Finn, D, Walsh, K, Roberson, D, McMahon, CJ. Myocardial fistulisation and coronary arterial ectasia in children with univentricular circulation: An under-recognised problem. Pediatr Cardiol 2018; 39: 254–260.CrossRefGoogle Scholar
Tannous, P, Ghelani, SJ, Marshall, AC, Porras, D. Angiographically detectable Thebesian veins are a dynamic and reversible finding in the setting of congenital heart disease. Congenit Heart Dis 2017; 12: 467–474.CrossRefGoogle ScholarPubMed
Lowry, AW, Olabiyi, OO, Adachi, I, Moodie, DS, and Knudson, JD. Coronary artery anatomy in congenital heart disease. Congenit Heart Dis 2013; 8: 187–202.CrossRefGoogle ScholarPubMed
Anderson, RH, Spicer, D. Fistulous communications with the coronary arteries in the setting of hypoplastic ventricles. Cardiol Young 2010; 20: 86–91.CrossRefGoogle ScholarPubMed
Nemoto, S, Sasaki, T, Ozawa, H, et al. Oral sildenafil for persistent pulmonary hypertension early after congenital cardiac surgery in children. Eur J Cardiothorac Surg 2010; 38: 71–77.CrossRefGoogle ScholarPubMed
Sharma, S, Taegtmeyer, H, Adrogue, J, et al. Dynamic changes of gene expression in hypoxia-induced right ventricular hypertrophy. Am J Physiol Heart Circ Physiol 2004; 286: H1185–H1192.CrossRefGoogle ScholarPubMed
Ansari, A. Anatomy and clinical significance of ventricular Thebesian veins. Clin Anat 2001; 14: 102–110.3.0.CO;2-4>CrossRefGoogle ScholarPubMed
Semenza, GL. Oxygen sensing, hypoxia-inducible factors, and disease pathophysiology. Annu Rev Pathol 2014; 9: 47–71.CrossRefGoogle ScholarPubMed
McMahon, CJ, Coleman, D, Oslizlok, P. Extensive coronary arterial fistula development in patients with univentricular circulation. Catheter Cardiovasc Interv 2014; 84: 811–814.CrossRefGoogle ScholarPubMed
Doganci, S, Yildirim, V, Yesildal, F, et al. Comparison of angiogenic and proliferative effects of three commonly used agents for pulmonary artery hypertension (sildenafil, iloprost, bosentan): is angiogenesis always beneficial? Eur Rev Med Pharmacol Sci 2015; 19: 1900–1906.Google ScholarPubMed
Zhu, B, Zhang, L, Alexeyev, M, et al. Type 5 phosphodiesterase expression is a critical determinant of the endothelial cell angiogenic phenotype. Am J Physiol Lung Cell Mol Physiol 2009; 296: L220–L228.CrossRefGoogle ScholarPubMed
Sahara, M, Sata, M, Toshihiro Morita, T, Nakajima, T, Hirata, Y, Nagai, R. A phosphodiesterase-5 inhibitor vardenafil enhances angiogenesis through a protein kinase G–dependent hypoxia-inducible factor-1/vascular endothelial growth factor pathway. Arterioscler Thromb Vasc Biol 2010; 30: 1315–1324.CrossRefGoogle ScholarPubMed
Constantinescu, MI, Bolfa, PF, Constantinescu, D, Mironiuc, AI, Gherman, CD. Treatment with sildenafil and donepezil improves angiogenesis in experimentally induced critical limb ischemia. BioMed Res Inter 2017; 2: 1–11.CrossRefGoogle Scholar
Hsu, SJ, Lin, TY, Wang, SS, et al. Endothelin receptor blockers reduce shunting and angiogenesis in cirrhotic rats. Eur J Clin Invest 2016; 46: 572–580.CrossRefGoogle ScholarPubMed
Wanga, G, Li, PZ, Zhang, SY, et al. Lipopolysaccharides (LPS) induced angiogenesis during chicken embryogenesis is abolished by combined ETA/ETB receptor blockade. Cell Physiol Biochem 2018; 48: 2084–2090.CrossRefGoogle Scholar
Wearn, JT. The role of the Thebesian vessels in the circulation of the heart. J Exp Med 1928; 47: 293–315.CrossRefGoogle ScholarPubMed
Snipelisky, D, Reddy, YNV, Lennon, RJ, Crusan, DJ, Rihal, CS, Lapeyre, AC. Cardiac structural changes and long-term survival in patients with prominent Thebesian veins. Am J Cardiol 2016; 118: 1264e–1267e.CrossRefGoogle ScholarPubMed
Khoury, G, Baydoun, H, Rafeh, NA, McCord, D, Olkovky, Y. Persistent Thebesian vessels involving the right and left ventricles leading to coronary steal phenomena and ischemia. Congenit Heart Dis 2014; 9: E61–E65.CrossRefGoogle Scholar
Hernández, M, Carretero, JM, Prada, F. Propranolol as a treatment for multiple coronary artery micro-fistulas. CardiolYoung 2015; 25: 380–383.Google ScholarPubMed