Coronary artery-cardiac chamber shunt: cineangiographic analysis.
Coronary artery-cardiac chamber shunts (CA-CC shunts) were observed in 101 out of 2267 consecutive patients (4.5%) receiving selective coronary angiography. In these patients, contrast medium injected into the coronary artery escaped directly into the cardiac chamber. CA-CC shunts were angiographically classified into the following two types. Type I: The endocardial layer was diffusely opacified, and contrast medium escaped into the cardiac chamber on systole (n = 83). Type II: Contrast medium escaped directly into the cardiac chamber via an undilated branch (n = 11). Type I and type II shunts were observed simultaneously in 7 patients. It is speculated that type I is a shunt via a persistent arterio-sinusoidal vessel, while type II is a shunt via a persistent arterio-luminal vessel. Both types were observed frequently (24.9%) in hypertrophic cardiomyopathy. The degree of CA-CC shunts in hypertrophic cardiomyopathy was not influenced by the presence or absence of myocardial squeezing. CA-CC shunts are considered to be due to an abnormality in the coronary microcirculation of the myocardium. We describe the angiographic features of the two types of CA-CC shunt and discuss their pathophysiological significance.
Matsunaga
N
N
Department of Radiology, Nagasaki University School of Medicine, Japan.
Hayashi
K
K
Matsuoka
Y
Y
Sakamoto
I
I
Ito
M
M
Hombo
Z
Z
Imamura
T
T
Oku
Y
Y
Kuriya
T
T
Hashiba
K
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D002932:Cineangiography; D003287:Contrast Media / Q000008:administration & dosage; D017023:Coronary Angiography; D003330:Coronary Vessel Anomalies / Q000145:classification / Q000000981:diagnostic imaging*; D006321:Heart / Q000000981:diagnostic imaging; D006330:Heart Defects, Congenital / Q000145:classification / Q000000981:diagnostic imaging*; D006801:Humans; D008875:Middle Aged
D003287:Contrast Media