Multiple Coronary Chamber Microfistulas or Persistent Thebesian Vessels?

Open access

Abstract

Coronary fistulas are rare, not gender-specific congenital conditions, consisting of communications between the coronary arteries and either another coronary vessel or a cardiac chamber. In contrast to large fistulas, small fistulas, named “minimae cordis veneae” or the Thebesius venous system, are draining into heart chambers and form a vascular network in the cardiac lumen. In this article, we present the case of a 72-year-old female with a significant history of cardiovascular disease, admitted to our clinic because of rest dyspnea, fatigue, and minimal chest pain. The 12-lead electrocardiogram showed a trifascicular block (a second-degree atrioventricular block Mobitz II, associated with a right bundle branch block and left anterior fascicle block) and negative T waves in DII, DIII, aVF, V4–V6 leads. An invasive coronary angiography was performed, which revealed no significant atherosclerotic lesions. However, a persistent capillary blush was present at the apex site of the left ventricular chamber, draining from the distal segments of both the anterior descending coronary artery and the posterior interventricular coronary artery. The intramural vascular network generating a left ventricle angiogram image of this kind was suggestive for persistent Thebesian vessels connecting the two coronaries with the left ventricular chamber.

1. Stierle U, Giannitsis E, Sheikhzadeh A, Potratz J. Myocardial ischemia in generalized coronary artery left ventricular microfistulae. Int J Cardiol. 1998;63:47-52.

2. Vavuranakis M, Bush CA, Boudoulas H. Coronary artery fistulas in adults: incidence, angiographic characteristics, natural history. Cathet Cardiovasc Diagn. 1995;35:116-120.

3. Blake HA, Manion WC, Mattingly TW, Baroldi G. Coronary artery anomalies. Circulation. 1964;30:927s-940s.

4. Ho HH, Cheung CW, Jim MH, Lam L. Coronary cameral fistula. Heart. 2005;91:1540.

5. Alkhulaifi AM, Horner SM, Pugsley WB, Swanton RH. Coronary artery fistulas presenting with bacterial endocarditis. Ann Thorac Surg. 1995;60:202-204.

6. Skimming JW, Walls JT. Congenital coronary artery fistula suggesting a “steal phenomenon” in a neonate. Pediatr Cardiol. 1993;14:174-175.

7. Ravin MB, Epstein RM, Malm JR. Contribution of Thebesian veins to the physiologic shunt in anesthetized man. J Appl Physiol. 1965;20:1148-1152.

8. Vogelbach KH, Edmiston WA, Stenson RE. Coronary artery-left ventricular communications: a report of two cases and review of the literature. Cathet Cardiovasc Diagn. 1979;5:159-167.

9. Heper G, Kose S. Increased myocardial ischemia during nitrate therapy: caused by multiple coronary artery-left ventricle fistulae? Tex Heart Inst J. 2005;32:50-52.

10. Nagueh SF, Smiseth OA, Appleton CP, et al. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2016;17:1321-1360.

11. Brignole M, Auricchio A, Baron-Esquivias G, et al. 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. European Heart Journal. 2013;34:2281-2329.

12. Thebesius AC. Disputatio medica inauguralis de circulo sanguinis in corde. Leiden; 1708.

13. Wearn JT. The role of the Thebesian vessels in the circulation of the heart. J Exp Med. 1928;47:293-315.

14. Wearn JT, Mettier SR, Klumpp TG, Zschiesche LJ. The nature of the vascular communications between the coronary arteries and the chambers of the heart. Am Heart J. 1933;9:143-164.

15. Ansari A. Anatomy and clinical significance of ventricular Thebesian veins. Clin Anat. 2001;14:102-110.

16. Boeder NF, Nef HM, Bauer T. Thebesian veins as drainage to the ventricle: A case report. Cardiovasc Revasc Med. 2017;18:213-214.

Journal Information

Metrics

All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 143 104 7
PDF Downloads 69 58 5