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Congenital coronary artery fistulas complicated with pulmonary hypertension: Analysis of 211 cases

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World Journal of Cardiology 2016年第10期8卷 596-605页

作者： salah am said Department of Cardiology Hospital Group Twente

AIM To compare the behavior of pulmonary hypertension(PHT) associated with coronary artery fistulas(CAFs) between the Asian and Caucasian *** CAFs may be complicated with PHT secondary to leftto-right shunt. Literature review limited to the English language. A total of 211 reviewed patients were collected. Of those, 111 were of Asian and 100 were of Caucasian ethnic origin. The mean age of the Asian and the Caucasian groups of patients were 48.9(range 19-83) and 49.9 years(range 16-85), respectively. In both groups, right heart catheterization was the most commonly(95%) used method for determining pulmonary artery pressure. RESULTS From all of the reviewed subjects, PHT was found in 49 patients(23%), of which 15 were Asian and 34 were Caucasian. In 75% of PHT subjects, mild to moderate PHT was reported and 76% of the fistulas had a vascular mode of termination. Treatment was surgical in 61%, followed by percutaneous therapeutic embolization(27%) and finally conservative medical management in 12% of PHT subjects. PHT was associated with a slight female gender predominance. The majority demonstrated mild to moderate PHT. PHT was reported more frequent in the Caucasian compared with the Asian ethnicity group. The majority of fistulas in patients with PHT had a vascular mode of termination. The results of this review are intended to be indicative and require cautious *** The likelihood for a CAF patient to develop PHT is presented when possessing the following features, with a Caucasian female having a fistula with a vascular mode of termination.

关键词： Congenital coronary artery fistulas Congenital anomaly Pulmonary hypertension Asian population Caucasian population

Current characteristics of congenital coronary artery fistulas in adults:A decade of global experience

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World Journal of Cardiology 2011年第8期3卷 267-277页

作者： salah am said Department of Cardiology Hospital Group TwenteLocation Hengelo7555 DL HengeloThe Netherlands

AIM:To describe the characteristics of coronary artery fistulas(CAFs) in adults,including donor vessels and whether termination was cameral or vascular. METHODS:A PubMed search was performed for articles between 2000 and 2010 to describe the current characteristics of congenital CAFs in adults.A group of 304 adults was *** data,presentations,diagnostic modalities,angiographic fistula findings and treatment strategies were gathered and *** regard to CAF origin,the subjects were tabulated into unilateral,bilateral or multilateral fistulas and *** group was stratified into two major subsets according to the mode of termination;coronary-cameral fistulas(CCFs) and coronary-vascular fistulas(CVFs) . A comparison was made between the two subsets. Fistula-related major complications[aneurysm formation,infective endocarditis(IE) ,myocardial infarction(MI) ,rupture,pericardial effusion(PE) and tamponade] were *** artery-ventricular multiple micro-fistulas and acquired CAFs were excluded as well as anomalous origin of the coronary arteries from the pulmonary artery(PA) . RESULTS:A total of 304 adult subjects(47%male) with congenital CAFs were *** mean age was51.4 years(range,18-86 years) ,with 20%older than 65 years of ***(31%) ,chest pain(23%) and angina pectoris(21%) were the prevalent clinical *** cardiac murmur was heard in 82%of the *** the applied diagnostic modalities,chest X-ray showed an abnormal shadow in 4%of the *** cornerstone in establishing the diagnosis was echocardiography(68%) ,and conventional contrast coronary angiography(97%) .However,multislice detector computed tomography was performed in 16%.The unilateral fistula originated from the left in 69%and from the right coronary artery in 31%of the *** patients(80%) had unilateral fistulas,18%presented with bilateral fistulas and 2%with multilateral *** into the PA was reported in

关键词： Coronary artery fistulas Congenital heart defect Coronary angiography Multi-detector computed tomography angiography

Acquired aortocameral fistula occurring late after infective endocarditis: An emblematic case and review of 38 reported cases

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World Journal of Cardiology 2016年第8期8卷 488-495页

作者： salah am said Massimo A Mariani Department of Cardiology Hospital Group Twente Thorax Centre Department of Cardiac Surgery University Medical Center Groningen

AIM To delineate the features and current therapeutic option of congenital and acquired aortocameral fistulas(ACF) secondary to iatrogenic or infectious *** From a Pub Med search using the term "aortocameral fistula", 30 suitable papers for the current review were retrieved. Reviews, case series and case reports published in English were considered. Abstracts and reports from scientific meetings were not included. A total of 38 reviewed subjects were collected and analyzed. In addition, another case- an adult male who presented with ACF between commissures of the right and noncoronary sinuses and right atrium as a late complication of Staphylococcus aureus infective endocarditis of the AV- is added, the world literature is briefly *** A total of thirty-eight subjects producing 39 fistulas were reviewed, analyzed and stratified into either congenital(47%) or acquired(53%) according to their etiology. Of all subjects, 11% were asymptomatic and 89% were symptomatic with dyspnea(21 ×) as the most common presentation. Diagnosis was established by a multidiagnostic approach in 23(60%), single method in 14(37%)(echocardiography in 12 and catheterization in 2), and at autopsy in 2(3%) of the subjects. Treatment options included percutaneous transcatheter closure in 12(30%) with the deployment of the amplatzer duct or septal occluder and Gianturco coil and surgical correction in 24(63%). CONCLUSION Acquired ACF is an infrequent entity which may occur late after an episode of endocarditis of the native AV. The management of ACF is generally by surgical correction but non-surgical device intervention has recently been introduced as a safe alternative.

关键词： Aortic-atrial shunt Aortic-atrial fistulas Infective endocarditis Late complication Surgical correction

Coronary-cameral fistulas in adults(first of two parts)

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World Journal of Cardiology 2013年第9期5卷 329-336页

作者： salah am said Rikke HM Schiphorst Richard Derksen Lodewijk Wagenaar Department of Cardiology Hospital Group Twente Department of Cardiology Thoraxcentrum TwenteMedisch Spectrum Twente Department of Cardiology Rijnstate Hospital

This is a case series and review of the literature adding11 new ***-cameral fistulas(CCFs)are infrequent anomalies which are in general co-incidentally found during diagnostic coronary angiography(CAG).To delineate the characteristics of congenital and acquired CCFs in adults,we performed a PubMed search for papers dealing with congenital or acquired CCFs in *** on coronary-vascular fistulas or paediatric subjects were not *** the world literature,a total of 243 adult patients were identified who had congenital(65%)or acquired(35%)*** this review,which is part one of a two-part series on CCFs,we describe and discuss the congenital fistulas,give an overview on the published literature and report details of our own series of 11 patients with MMFs and solitary macro *** the congenital group,56%were small or large solitary macro CCFs(cut-off 1.5mm)and 9%were coronary artery-ventricular multiple micro-fistulas(MMFs).Apical hypertrophic cardiomyopathy was reported in some of the reviewed subjects with MMFs(3/24=13%)but not was seen in our own *** medical management was generally the treatment of choice in congenital MMFs;prophylactic implantable cardioverter defibrillators(ICD)were implanted in 2/24(8%)of subjects,especially when extensive micro-fistulisations were *** of the patients of our own series required an ICD,as the MMFs were of limited *** or acquired CCFs in adults are infrequent anomalies having a wide spectrum of clinical presentation may varies from asymptomatic to severely devastating states requiring different treatment modalities.

关键词： Congenital heart defect Congenital coronary artery-ventricular multiple micro-fistulas Congenital coronary-cameral fistulas Coronary angiography Adults

Cardiac and non-cardiac causes of T-wave inversion in the precordial leads in adult subjects: A Dutch case series and review of the literature

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World Journal of Cardiology 2015年第2期7卷 86-100页

作者： salah am said Rene Bloo Ramon de Nooijer Andries Slootweg Department of Cardiology Hospital Group TwenteAlmelo-Hengelo7555 DL Hengelo The Netherlands

AIM: To describe the electrocardiographic(ECG) phenomena characterized by T-wave inversion in the precordial leads in adults and to highlight its differential diagnosis. METHODS: A retrospective chart review of 8 adult patients who were admitted with ECG T-wave inversion in the anterior chest leads with or without prolongation of corrected QT(QTc) interval. They had different clinical conditions. Each patient underwent appropriate clinical assessment including investigation for myocardial involvement. Single and multimodality noninvasive, semi-invasive and invasive diagnostic approach were used to ascertain the diagnosis. The diagnostic assessment included biochemical investigation, cardiac and abdominal ultrasound, cerebral and chest computed tomography, nuclear medicine and coronary ***: Eight adult subjects(5 females) with a mean age of 66 years(range 51 to 82) are analyzed. The etiology of T-wave inversion in the precordial leads were diverse. On admission, all patients had normal blood pressure and the ECG showed sinus rhythm. Five patients showed marked prolongation of the QTc interval. The longest QTc interval(639 ms) was found in the patient with pheochromocytoma. Giant T-wave inversion(≥ 10 mm) was found in pheochromocytoma followed by electroconvulsive therapy and finally ischemic heart disease. The deepest T-wave was measured in lead V3(5 ×). In 3 patients presented with mild T-wave inversion(patients 1, 5 and 4 mm), the QTc interval was not prolonged(432, 409 and 424 msec), ***: T-wave inversion associated with or without QTc prolongation requires meticulous history taking, physical examination and tailored diagnostic modalities to reach rapid and correct diagnosis to establish appropriate therapeutic intervention.

关键词： T-wave inversion Coronary angiography Pulmonary computed tomography angiography Mag-netic resonance imaging Differential diagnosis

Exercise-induced left bundle branch block: an infrequent phenomenon: Report of two cases

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World Journal of Cardiology 2013年第9期5卷 359-363页

作者： salah am said Marisa Bultje-Peters Rogier LG Nijhuis Department of Cardiology Hospital Group Twente

Exercise-induced left bundle branch block(EI-LBBB)is infrequent *** present two patients with angina pectoris who developed EI-LBBB during exercise tolerance *** first patient with typical angina pectoris had significant obstructive coronary artery disease(CAD)requiring percutaneous coronary intervention of multiple lesions including placement of drug eluting *** second patient had atypical chest pain without signs of CAD at ***-LBBB occurred at a heart rate of 80 bpm and 141 bpm in the first and second patient,***-LBBB remained visible through the test till the recovery period in the first patient at a heart rate of 83 bpm and disappeared at 96bpm in the second *** patients with this infrequent phenomenon are discussed and the literature is reviewed.

关键词： Angina pectoris Electrocardiography Exercise tolerance test Left bundle branch block Coronary artery disease.

Coronary-cameral fistulas in adults: Acquired types(second of two parts)

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World Journal of Cardiology 2013年第12期5卷 484-494页

作者： salah am said Rikke HM Schiphorst Richard Derksen Lodewijk J Wagenaar Department of Cardiology Hospital Group Twente Department of Cardiology Thoraxcentrum TwenteMedisch Spectrum Twente Department of Cardiology Rijnstate Hospital

Acquired coronary artery fistulas(CCFs)are infrequently detected during conventional coronary *** delineate the characteristics of congenital(first part)and acquired(second part)CCFs in adults,a PubMed search was conducted for papers dealing with congenital or acquired *** of the publications describing patients with coronary-vascular fistulas were *** dealing with pediatric subjects were *** the world literature,a total of 243adult patients were selected who had congenital(n=159/243,65%)and acquired(n=84/243,35%)*** the acquired types(n=72,85.7%)were traumatic(iatrogenic(n=65/72,90%),accidental(n=7/72,10%)and(n=12,14.3%)spontaneously developing in relation to severe coronary atherosclerosis or myocardial infarction.A high incidence of spontaneousresolution of iatrogenic CCFs resulting from endomyocardial biopsy or following post-septal myectomy was *** CCFs associated with myocardial ischemia or infarction resolved completely in 8%of the *** surgical intervention was the treatment of choice in acquired traumatic accidental *** congenital types are addressed in a previous issue of this journal(first part).In this review(second of two parts,partⅡ),we describe the acquired coronarycameral fistulas.

关键词： Acquired coronary-cameral fistulas Accidental coronary-cameral fistulas Iatrogenic coronarycameral fistulas Spontaneous coronary-cameral fistulas Coronary angiography,Spontaneous resolution Surgical treatment

Coronary artery disease in congenital single coronary artery in adults:A Dutch case series

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World Journal of Cardiology 2014年第4期6卷 196-204页

作者： salah am said Willem G de Voogt Suat Bulut Jacques Han Peter Polak Rogier LG Nijhuis Jeroen W op den Akker Andries Slootweg Department of Cardiology Hospital Group Twente Almelo-Hengelo Department of Cardiology St.LucasAndreas Hospital Department of Cardiology Gelre Hospital Zutphen Department of Cardiology Hospital De Sionsberg Department of Cardiology St.Anna Hospital Department of Radiodiagnostics Hospital Group Twente Almelo-Hengelo

AIM:To assess the current diagnostic and therapeutic management and the clinical implications of congenital single coronary artery(SCA) in ***:We identified 15 patients with a SCA detected from four Dutch angiography centers in the period between 2010 and *** patients who underwent routine diagnostic coronary angiography(CAG) for suspected coronary artery disease and who incidentally were found to have isolated SCA were ***:Fifteen(7 females) with a mean age of 58.5 ± 13.78 years(range 43-86) had a *** demonstrated congenital isolated SCA originating as a single ostium from the right sinus of Valsalva in 6 patients and originating from the left in 9 *** to moderate coronary atherosclerotic changes were found in 4,and severe stenotic lesions in another 4 *** patients were free of coronary *** of non-sustained ventricular tachycardia were documented in 2 patients,one of whom demonstrated transmural ischemic changes on *** perfusion scintigraphic evidence of transmural myocardial ischemia was found in 1 patient due to kinking and squeezing of the SCA with an interarterial course between the aorta and pulmonary ***-slice computed tomography(MSCT) was helpful to delineate the course of the anomalous artery relative to the aorta and pulmonary *** coronary intervention was successfully performed in 3 *** patients were managed *** bypass graft was performed in 4 patients with the squeezed ***:SCA may be associated with transient transmural myocardial ischemia and aborted sudden death in the absence of coronary *** availability and sophistication of MSCT facilitates the delineation of the course of a *** present a Dutch case series and review of the literature.

关键词： Congenital heart disease Coronary artery anomaly Coronary angiography Single coronary artery Coronary artery disease Multi-slice computed tomography

Incidental congenital coronary artery vascular fistulas in adults:Evaluation with adenosine-13N-ammonia PET-CT

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World Journal of Cardiology 2018年第10期10卷 153-164页

作者： salah am said Aly Agool Arno HM Moons Mounir WZ Basalus Nils RL Wagenaar Rogier LG Nijhuis Jutta M Schroeder-Tanka Riemer HJA Slart Department of Cardiology Hospital Group TwenteAlmelo-Hengelo 7555 DLOverijsselThe Netherlands Department of Nuclear Medicine Hospital Group TwenteAlmelo-Hengelo 7555 DLOverijsselThe Netherlands Department of Cardiology Slotervaart HospitalAmsterdam 1066 ECNorth HollandThe Netherlands Department of Cardiology Hospital Onze Lieve Vrouwe GasthuisLocation WestAmsterdam 1061 AENorth HollandThe Netherlands Department of Nuclear Medicine and Molecular Imaging University Medical Center GroningenGroningen 9713 GZThe Netherlands Faculty of Science and Technology Biomedical Photonic ImagingUniversity of TwenteEnschede 7522 NBThe Netherlands

AIM To assess the functionality of congenital coronary artery fistulas(CAFs) using adenosine stress ^(13)N-ammonia positron emission tomography computed tomography(PET-CT).METHODS Congenital CAFs were incidentally detected during coronary angiography(CAG) procedures in 11 adult patients(six males and five females) with a mean age of 64.3 years(range 41-81). Patients were collected from three institutes in the Netherlands. The characteristics of the fistulas(origin, pathway and termination), multiplicity of the origins and pathways of the fistulous vessels were assessed by CAG. Five patients underwent adenosine pharmacologic stress ^(13)N-ammonia PET-CT to assess myocardial perfusion and the functional behavior of the fistula. RESULTS Eleven patients with 12 CAFs, 10 unilateral and one bilateral, originating from the left anterior descending coronary artery(n = 8), right coronary artery(n = 2) and circumflex(n = 2). All fistulas were of the vascular type, terminating into either the pulmonary artery(n = 11) or coronary sinus(n = 1). The CAG delineated the characteristics of the fistula(origin, pathway and termination). Multiplicity of the origins and pathways of the fistulous vessels were common in most fistulas(8/12, 67% and 9/12, 75%, respectively). Multiplicity was common among the different fistula components(23/36, 64%). Adenosine pharmacologic stress ^(13)N-ammonia PET-CT revealed normal myocardial perfusion and ejection fraction in all but one patient, who showed a reduced ejection *** PET-CT may be helpful for assessing the functional status of congenital CAFs in selected patients regarding clinical decision-making. Studies with a larger patient series are warranted.

关键词： Coronary angiography Coronary-pulmonary artery fistulas Adenosine ammonia positron emission tomography computed tomography Coronary vascular fistulas Congenital coronary artery fistulas