<abstract xmlns="http://www.w3.org/1999/xhtml"><p> Bicoronary - pulmonary artery fistulae are rare conditions. Their association with mitral valve prolapse is even rarer and randomly reported. This association is important to be recognized in clinical practice because of the differential diagnose problems. Closing the coronary fistulae and mitral valve replacement during the same surgical procedure is probably the optimal management of these patients. We report a case involving the correction of congenital bicoronarypulmonary artery fistulae and mitral valve replacement within the same surgical procedure in a 56 years old female patient with angina and clinical signs of left ventricular failure associating the fistulae to severe mitral regurgitation due to mitral valve prolapse. Past medical history revealed autoimmune thyroiditis, atrial fibrillation, mitral and tricuspid valve regurgitation. At admission physical examination revealed stable vital signs, irregular tachycardia with significant pulse and a mitral regurgitation systolic murmur. ECG showed atrial fibrillation, no ischemia. Echocardiography revealed severe mitral regurgitation, prolapse of anterior and posterior mitral leaflets, moderate tricuspid valve regurgitation, and mild pulmonary hypertension. Coronary angiogram showed no significant lesions of the epicardial vessels but high flow congenital bicoronary-pulmonary fistulae (right coronary artery and left coronary artery to main pulmonary artery). Surgical correction of the congenital bicoronarypulmonary fistulae was performed simultaneously with mitral valve replacement in the same session. Postsurgical evolution was uneventful. Post-procedural ECG showed atrial fibrillation with a controlled heart rate, postoperative echocardiography showed normal functional and normal positioned prosthetic mitral mechanical valve, and rather normal left ventricle function. Coexistence of bicoronary-pulmonary fistulae and mitral valve insufficiency due to prolapse in a symptomatic patient with angina pectoris is a very rare clinical entity. Solving both abnormalities within the same surgical procedure was the optimal management for this patient. </p></abstract>

Bicoronary - pulmonary artery fistulae are rare conditions. Their association with mitral valve prolapse is even rarer and randomly reported. This association is important to be recognized in clinical practice because of the differential diagnose problems. Closing the coronary fistulae and mitral valve replacement during the same surgical procedure is probably the optimal management of these patients. We report a case involving the correction of congenital bicoronarypulmonary artery fistulae and mitral valve replacement within the same surgical procedure in a 56 years old female patient with angina and clinical signs of left ventricular failure associating the fistulae to severe mitral regurgitation due to mitral valve prolapse. Past medical history revealed autoimmune thyroiditis, atrial fibrillation, mitral and tricuspid valve regurgitation. At admission physical examination revealed stable vital signs, irregular tachycardia with significant pulse and a mitral regurgitation systolic murmur. ECG showed atrial fibrillation, no ischemia. Echocardiography revealed severe mitral regurgitation, prolapse of anterior and posterior mitral leaflets, moderate tricuspid valve regurgitation, and mild pulmonary hypertension. Coronary angiogram showed no significant lesions of the epicardial vessels but high flow congenital bicoronary-pulmonary fistulae (right coronary artery and left coronary artery to main pulmonary artery). Surgical correction of the congenital bicoronarypulmonary fistulae was performed simultaneously with mitral valve replacement in the same session. Postsurgical evolution was uneventful. Post-procedural ECG showed atrial fibrillation with a controlled heart rate, postoperative echocardiography showed normal functional and normal positioned prosthetic mitral mechanical valve, and rather normal left ventricle function. Coexistence of bicoronary-pulmonary fistulae and mitral valve insufficiency due to prolapse in a symptomatic patient with angina pectoris is a very rare clinical entity. Solving both abnormalities within the same surgical procedure was the optimal management for this patient.

Bicoronary-pulmonary fistulae and severe mitral valve regurgitation – uncommon cause of myocardial ischemia – a case report

Cardiac Catheterization Laboratory, Centre of Cardiovascular Diseases, University of Medicine and Pharmacy at Tîrgu Mureş, Romania

Cardiovascular Surgery Clinic, Centre of Cardiovascular Diseases, University of Medicine and Pharmacy at Tîrgu Mureş, Romania

Cardiac Rehabilitation Clinic, Emergency County Clinical Hospital Tîrgu Mureş, University of Medicine and Pharmacy at Tîrgu Mureş, Romania

Infectious Disease Clinic, County Clinical Hospital Tîrgu Mureş, University of Medicine and Pharmacy at Tîrgu Mureş, Romania

ARS Medica Tomitana

Bicoronary - pulmonary artery fistulae are rare conditions. Their association with mitral valve prolapse is even rarer and randomly reported. This association...

Bicoronary-pulmonary fistulae and severe mitral valve regurgitation – uncommon cause of myocardial ischemia – a case report

Published Online: Mar 13, 2013

Page range: 135 - 139

DOI: https://doi.org/10.2478/v10307-012-0024-8

Keywords
bicoronary-pulmonary fistulae, mitral regurgitation, mitral valve prolapse, angina pectoris

This content is open access.

Bicoronary-pulmonary fistulae and severe mitral valve regurgitation – uncommon cause of myocardial ischemia – a case report

Published Online: Mar 13, 2013

Page range: 135 - 139

DOI: https://doi.org/10.2478/v10307-012-0024-8

Keywordsbicoronary-pulmonary fistulae, mitral regurgitation, mitral valve prolapse, angina pectoris

This content is open access.

Keywords
bicoronary-pulmonary fistulae, mitral regurgitation, mitral valve prolapse, angina pectoris