Abstract
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.
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References
Wearn JT. The role of the Thebesian vessels in the circulation of the heart. J Exper Med 1928; 47: 293–316.
Wearn JT, Mettier SR, Klumpp TH, Zschiesche LJ. The nature of the vascular communications between the coronary arteries and the chamber of the heart. Am Heart J 1933; 9: 143–164.
Neufeld HN, Lester RG, Adams P Jr, Anderson RC, Lillehei CW. Congenital communication of a coronary artery with a cardiac chamber or the pulmonary trunk (‘coronary artery fistula’). Circulation 1961; 24: 171–9.
Matsunaga N. Radiological evaluation of coronary artery-cardiac chamber shunt [In Japanese]. Nippon Acta Radiologica 1987; 47: 1170–80.
Vieussens R. Nouvelles decouvertes sur le coeur. Paris, 1706.
Gould SE, Ioannides G. Diseases of the coronary vessels. In: Gould SE, editor. Pathology of the heart and blood vessels. 3rd ed. Springfield: Charles C Thomas, 1968: 545.
Blake HA, Manion WC, Mattingly TW, Baroldi G. Coronary artery anomalies. Circulation 1964; 30: 927–40.
Jenni R, Goebel N, Tartini R, Scneider J, Arbenz U, Oelz O. Persistent myocardial sinusoids of both ventricles as an isolated anomaly; Echocardiographic, angiographic, and pathologic anatomical findings. Cardiovasc Intervent Radiol 1986; 9: 127–31.
Grant RT. An unusual anomaly of the coronary vessels in the malformed heart of a child. Heart 1926; 13: 273–83.
Williams RR, Kent GB Jr., Edwards JE. Anomalous cardiac blood vessel communicating with right ventricle; Observation in case of pulmonary atresia with intact ventricular septum. Arch Path 1951; 52: 480–7.
Lauer RM, Fink HP, Petry EL, Dunn MI, Diehl AM. Angiographic demonstration of intramyocardial sinusoids in pulmonary valve atresia with intact ventricular septum and hypoplastic right ventricle. N Engl J Med 1964; 271: 68–72.
Bellet S, Gouley BA. Congenital heart disease with multiple cardiac anomalies; Report of case showing aortic atresia, fibrous scar in myocardium, and embryonal sinusoidal remains. Am L Med Sci 1932; 183: 458–65.
Bjork VO, Bjork L. Intramural coronary artery aneurysm. J Thorac Cardiovasc Surg 1967; 54: 50–2.
Edwards JE, Minn R, Gladding TC, Weir AB, Tenn M. Congenital communication between the right coronary artery and the right atrium. J Thorac Surg 1958; 35: 662–73.
Grant RT. Development of the cardiac coronary vessels in the rabbit. Heart 1926; 13: 261–71.
Bloor CM, Liebow AA. Coronary collateral circulation. Am J Cardiol 1965; 16: 238–52.
Thebesius AC, Dissertatio medica de circulo sanguinis in corde. Batavorum: Lugdunum, 1708.
Grant RT, Viko LE. Observation on the anatomy of the Thebesian vessels of the heart. Heart 1929; 15: 103–23.
Barry A, Patten BM. The structure of the heart. In: Gould SE, editor. Pathology of the heart and blood vessels. 3rd ed. Springfield: Charles C Thomas, 1968: 91.
Searcy RA, Stein PD, Ganesan G, Bruce TA. Arterio-atrial shunting in coronary atherosclerosis. Chest 1971; 59: 398–401.
Wenger NK, Goodwin JR, Roberts WC. Cardiomyopathy and myocardiac involvement with systemic disease. In: Hurst JW, editor. The heart, arteries, and veins. New York: McGraw-Hill, 1986; 1193–208.
Maron BK, Bonow RO, Cannon RO, Leon MB, Epstein SE. Hypertrophic cardiomyopathy: interpretations of clinical manifestations, pathophysiology, and therapy. N Engl J Med 1987; 316: 780–9, 844–52.
Pichard AD, Meller J, Techholz L, Lipnik S, Gorlin R, Herman MV. Septal perforator compression(narrowing) in idiopathic hypertrophic subaortic stenosis. Am J Cardiol 1977; 40: 310–4.
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Matsunaga, N., Hayashi, K., Matsuoka, Y. et al. Coronary artery-cardiac chamber shunt: cineangiographic analysis. Int J Cardiac Imag 8, 63–70 (1992). https://doi.org/10.1007/BF01137568
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DOI: https://doi.org/10.1007/BF01137568