Congenital abnormalities of the coronary arteries are found in 0.6% to 1.3% of patients in coronary angiography. Dual left anterior descending coronary artery (LAD) is a rare coronary anomaly and is incidentally detected during coronary angiography. We report a case of a 65-year-old female with a rare coronary anomaly who was diagnosed with dual LAD via coronary computed tomography and coronary angiography. The imaging studies revealed dual LAD originating from the left main stem and right coronary sinus. These angiographic findings were considered to be consistent with the type IV variety of dual LAD by Spindola-Franco classification. Recognition of dual LAD is important to prevent errors of interpretation of the coronary angiogram and for optimal surgery.
Aged ; Classification ; Congenital Abnormalities ; Coronary Angiography ; Coronary Sinus* ; Coronary Vessel Anomalies ; Coronary Vessels* ; Female ; Humans

OBJECTIVETo summarize the clinical characteristics, diagnosis and surgical in-treatment results of congenital coronary artery fistulas (CAF) in adults.

METHODSFourteen patients (8 men, 6 women), aged from 18 to 60 years with a mean of 32 +/- 13 years, underwent surgical correction of CAF between March 1985 and April 2002. Eleven of the 14 patients (78.57%) were symptomatic. The diagnosis of CAF was made by echocardiography or angiocardiography preoperatively. The fistulae originated from the right, left and double coronary arteries in 10 (71%), 3 (21%) and 1 (7%) patient(s), respectively. The fistulae drained into the right ventricle (8 patients), left ventricle (4), right atrium (1) and pulmonary artery (1), respectively. The diameter of fistulae ranged from 0.30 to 1.80 cm with a mean of (1.16 +/- 0.49) cm. There were 6 CAF patients associated with coronary artery aneurysms and 4 CAF patients with other coexisting cardiac defects. The distal fistulae were closed in 10 patients with cardiopulmonary bypass (CPB) and 4 patients without CPB. The coexisting defects were corrected simultaneously.

RESULTSThere was no early and late death. One patient had low cardiac output syndrome and cured during early postoperative period. Twelve patients (85.71%) were followed up for a mean period of 3.35 +/- 4.28 years without myocardial ischemia or infarction and recurrent fistulae. Heart function was improved to NYHA functional class I in 11 patients and class II in 1 patient.

CONCLUSIONSAll adult patients with CAF who have demonstrable hemodynamic and cardiovascular morphological changes should be surgically treated as early as possible. The appropriate surgical management and reliable myocardial protection are key points of good surgical results.

Adolescent ; Adult ; Coronary Vessel Anomalies ; diagnosis ; surgery ; Female ; Fistula ; congenital ; diagnosis ; surgery ; Humans ; Male ; Middle Aged

Adult ; Coronary Vessel Anomalies ; diagnosis ; etiology ; Humans ; Male ; Smoking ; adverse effects ; Vascular Diseases ; congenital ; diagnosis ; etiology

Microperforate hymen is a rare vaginal anomaly that is usually reported in childhood due to recurrent urogenital infections. Unlike imperforate hymen where the presenting complaints are classical due to complete vaginal obstruction, the less profound and varied presentation of microperforate hymen may go unnoticed. We report a case of a 39-year-old, with a background history of amenorrhea, who presented with acute abdomen suggestive of tubo-ovarian abscess, and was finally diagnosed to have microperforate hymen. She underwent hymenectomy to correct the anomaly. To our knowledge, this is the oldest age of presentation of a congenital form of microperforate hymen. A high index of suspicion and early detection of microperforate hymen and properly timed intervention is essential to prevent acute symptoms and long term detrimental sequalae to women’s reproductive and psychosexual health
congenital anomalies ; imperforate hymen ; microperforate hymen ; surgical correction ; tubo-ovarian abscess

Coronary Aneurysm ; Coronary Angiography ; Coronary Vessel Anomalies ; Humans ; Vascular Diseases/congenital*

Adolescent ; Coronary Angiography ; Coronary Vessel Anomalies ; pathology ; surgery ; Female ; Fistula ; congenital ; pathology ; surgery ; Humans ; Male ; Middle Aged

Coronary arteriovenous fistula (CAVF) is a rare condition defined as an anomalous termination of the coronary arteries. The etiology of CAVF is either congenital or acquired, and iatrogenic CAVF is most commonly caused by cardiovascular surgery or percutaneous intervention. Most of the prenatally diagnosed CAVFs were related to complex heart disease, and only few cases of an isolated CAVF have been reported to date. We successfully diagnosed an isolated CAVF by fetal echocardiography at 25.3 weeks of gestation. Accurate prenatal diagnosis resulted in the prompt decision for postnatal surgical correction, and the neonate thrived well without any complications.
Arteriovenous Fistula ; Coronary Vessel Anomalies ; Coronary Vessels ; Echocardiography ; Heart Defects, Congenital ; Heart Diseases ; Humans ; Infant, Newborn ; Pregnancy ; Prenatal Diagnosis

Anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a very rare congenital heart defect. Herein, we describe three cases of ARCAPA in an 8 months old, 18 months old, and 4 year old child. Two cases were incidentally diagnosed using a computed tomographic angiograph, and the other was incidentally diagnosed using a coronary angiograph. These cases underwent a reimplantation technique on diagnosis and resulting in positive clinical outcomes during the follow-up period which was a mean of 1.5 years.
Cardiac Surgical Procedures ; Child ; Congenital Abnormalities ; Coronary Vessel Anomalies ; Coronary Vessels* ; Diagnosis ; Electrocardiography ; Follow-Up Studies ; Heart Defects, Congenital ; Humans ; Pulmonary Artery* ; Replantation

BACKGROUND: For the surgical management of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), there have been various techniques that reduce the tension and kinking of the coronary artery during reimplantation to the aorta. The aim of this study is to describe the results of our modified technique of coronary reimplantation for the treatment of ALCAPA. METHODS: Between October 2003 and February 2011, seven patients underwent coronary reimplantation with the modified technique (tubing formation with the sinus wall of the pulmonary artery and trapdoor formation at the site of implantation in the aorta). The median follow-up duration was 52 months (range, 4 to 72 months). Clinical outcomes and serial echocardiographic data were reviewed. RESULTS: There was no mortality. One patient had a small amount of cerebral hemorrhage postoperatively and improved without any sequelae. Another patient had left diaphragm palsy and underwent diaphragm plication. Follow-up echocardiogram showed that all patients had normal ventricular function without chamber enlargement. CONCLUSION: Our modified technique (tubing formation with the sinus wall of the pulmonary artery and trapdoor formation at the site of implantation in the aorta) demonstrated successful clinical outcomes. We conclude that this surgical technique can be a potential alternative for the treatment of ALCAPA.
Aorta ; Bland White Garland Syndrome ; Cerebral Hemorrhage ; Coronary Vessel Anomalies ; Coronary Vessels* ; Diaphragm ; Echocardiography ; Follow-Up Studies ; Heart Defects, Congenital ; Humans ; Mortality ; Paralysis ; Pulmonary Artery* ; Replantation ; Ventricular Function

A coronary arteriovenous (AV) fistula consists of a communication between a coronary artery and a cardiac chamber, a great artery or the vena cava. It is the most common anomaly that can affect coronary perfusion. Yet bilateral involvement of a coronary fistula, constitutes an uncommon subgroup of coronary AV fistulas. We herein report on a case of bilateral coronary AV fistula that was coexistent with variant angina originating from the distal right ventricular branch of the right coronary artery and the distal septal branch of the left anterior descending artery, and the latter drained into the right ventricle.
Angina Pectoris, Variant/*etiology/radiography ; Coronary Vessel Anomalies/*complications/*diagnosis ; Female ; Heart Ventricles/*abnormalities ; Humans ; Middle Aged ; Vascular Fistula/complications/*congenital/*diagnosis