case_images: PMC10526361_01
case_images: Electrocardiograms and computed tomography myocardial perfusion imaging (CTP). (A) TII, III, AVF inversion was found in electrocardiogram before surgery; (B) TII, III, AVF inversion disappeared in electrocardiogram after surgery; (C) After the patient suffered from COVID-19, the ECG showed sinus tachycardia, and TII, III, AVF inversion again; (D) After increasing the therapeutic dose of metoprolol, the heart rate of this patient decreased from 105 beats per minute to 70 beats per minute, and the degree of inversion of TII, III, AVF significantly improved; (E) CTP in resting and exercise states showed hypoperfusion of inferior wall myocardium before surgery; (F) CTP in the patient's resting and exercise states showed the disappearance of myocardial hypoperfusion of inferior wall after surgery; (G) After COVID-19 infection, there was no abnormal myocardial blood flow perfusion in the patient's resting and exercise states.
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case_images: PMC10526361_01_fcvm-10-1238034-g001.jpg
case_images: F1
case_images: TII, III, AVF, V3-V6 (Figure 1A). Computed tomography myocardial perfusion imaging (CTP) in resting and exercise states indicated myocardial ischemia in the middle and base of the LV inferior wall (Figure 1E). AVF were found on the ECG (Figure 1B), and CTP did not reveal myocardial ischemia (Figure 1F). In the next five years, the patient occasionally had slight chest tightness but no chest pain. After taking metoprolol 25 mg per day, the symptoms were significantly relieved, and the frequency of attack was significantly reduced. TII, III, AVF (Figure 1C). TTE showed that in the diastole, the diameter of the orificium fistula was 2.5 mm, and the the Vmax was 145 cm/s. CTP (Figure 1G). Coronary artery computed tomography scan revealed a diameter of 13.5 mm for a distal coronary artery aneurysm (CAA) in the RCA (Figure 2D). AVF inversion (Figures 1C,D; Table 1). After 5 days, chest tightness and pain relieved.
case_images: Right coronary artery to left ventricular fistula complicated with coronary artery dilation. The contrast agent flowed directly into the left ventricular lumen through the right coronary artery fistula, and the arrows point to the left ventricular lumen and orificium fistulae respectively (A) The lumen diameter of the right coronary artery is 7.56 mm in the proximal part (B), 6.37 mm in the middle part (B) and 19.12 mm in the distal part (C). In the sixth year after surgery, Coronary artery computed tomography indicated that the diameter of the distal coronary artery aneurysm in the patient's RCA was 13.5 mm (D).
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case_images: F2
case_images: As a result, we unexpectedly discovered a fistula from the right coronary artery (RCA) to the LV cavity, showing a rapid flow of contrast agent from RCA into LV during diastole (Supplementary Material 1, Figure 2A), and the RCA was significantly dilated, especially at the distal end of the coronary artery (Supplementary Material 1, Figures 2B,C). CTP (Figure 1G). Coronary artery computed tomography scan revealed a diameter of 13.5 mm for a distal coronary artery aneurysm (CAA) in the RCA (Figure 2D).