[Coronary arteriovenous fistula. Apropos of a case with thallium myocardial scintigraphy and study of pre- and postoperative myocardial metabolism].
Coronary angiography performed in a 62 year old man with spontaneous chest pain revealed a congenital fistula in the form of a vascular network arising from the proximal part of the left anterior descending artery and draining into the main pulmonary artery. A single severe atheromatous stenosis of the right coronary artery was observed. Thallium 201 myocardial scintigraphy at rest showed a large area of hypofixation in the artero-septo-apical zone. Myocardial and aorto-right coronary bypass, myocardial scintigraphy became almost normal, leaving a small antero-septal and apical deficit: myocardial metabolism returned to normal. The fact that lactate metabolism is a particularly sensitive index of myocardial hypoxia in the territory of the left coronary artery suggests a probable coronary steal syndrome induced by the fistula; this is probably also the cause of the isotopic hypofixation in the territory of the left anterior descending artery which emphasizes the value of Thallium myocardial scintigraphy in the study of congenital malformations of the coronary artery.
D001165:Arteriovenous Malformations / Q000175:diagnosis* / Q000601:surgery; D017023:Coronary Angiography; D003327:Coronary Disease / Q000209:etiology; D003330:Coronary Vessel Anomalies / Q000175:diagnosis* / Q000601:surgery; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D007773:Lactates / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism; D011184:Postoperative Period; D011651:Pulmonary Artery / Q000002:abnormalities*; D011868:Radioisotopes; D011877:Radionuclide Imaging; D013793:Thallium
D007773:Lactates; D011868:Radioisotopes; D013793:Thallium
Fistule artérioveineuse coronaire. A propos d'un cas avec scintigraphie myocardique au thallium et étude du métabolisme myocardique pré et post-opératoires.