A Case of Multiple Coronary Artery-Left Ventricular Micro Fistulae Complicated With Hepatic Arteriovenous Fistulae

Ryoko Niwa; Eriko Hasumi; Kastuhito Fujiu; Masae Uehara; Daisuke Nitta; Masaru Hatano; Hiroshi Akazawa; Masafumi Watanabe; Issei Komuro

doi:10.1536/ihj.15-263

This article has now been updated. Please use the final version.

A Case of Multiple Coronary Artery-Left Ventricular Micro Fistulae Complicated With Hepatic Arteriovenous Fistulae

Ryoko Niwa, Eriko Hasumi, Kastuhito Fujiu, Masae Uehara, Daisuke Nitta, Masaru Hatano, Hiroshi Akazawa, Masafumi Watanabe, Issei Komuro

Author information

Ryoko Niwa
Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
Eriko Hasumi
Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
Kastuhito Fujiu
Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
Department of Ubiquitous Health Informatics, Graduate School of Medicine, The University of Tokyo
Masae Uehara
Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
Daisuke Nitta
Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
Masaru Hatano
Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
Hiroshi Akazawa
Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
Masafumi Watanabe
Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
Issei Komuro
Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo

Keywords: Cardiac magnetic resonance imaging (CMR), Late gadolinium enhancement (LGE), Coronary fistula, Cardiac hypertrophy

JOURNAL FREE ACCESS Advance online publication

Article ID: 15-263

DOI https://doi.org/10.1536/ihj.15-263

The final version of this article is now available: Vol. 57 (2016), No. 1 pp. 123-126

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Abstract

We present the first case of multiple coronary artery-left ventricular micro fistulae complicated with hepatic arteriovenous fistulae (AVF) in an adult patient. Multiple coronary artery fistulae originated from the left anterior descending coronary artery with aneurysmal change. Multiple coronary artery–left ventricular micro fistulae presented on the left ventricular wall and showed significant localized hypertrophic change. Stress and enhanced cardiac magnetic resonance imaging (CMR) revealed myocardial ischemia that could not be detected by stress Tl-201 cardiac scintigraphy, and late patchy gadolinium enhancement (LGE) in the mid-ventricular wall apex. This LGE pattern did not match the typical pattern observed in patients with apical hypertrophic cardiomyopathy. These observations may help distinguish multiple coronary artery-associated myocardial ischemia and hypertrophy from apical cardiomyopathy.

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