PS 08-73 STRANGE CONNECTIONS: CASE SERIES OF CORONARY ARTERIAL-VENOUS FISTULAS SEEN AT THE PHILIPPINE GENERAL HOSPITAL

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Abstract

Objective:

To present a case series of adult Filipino patients with coronary arterio venous fistulas.

Design and Method:

Case series

Results:

Clinical Presentation: The six patients were middle aged, 24–56 years old, four were males, and two were females. Four presented with recurrent chest pain, while the 24 year old female was asymptomatic and the 38 year old female patient had difficulty of breathing. All four male cases were hypertensive for an average of 5 years, three were smokers for more than 5 years. All six patients have normal left ventricular systolic function on transthoracic 2Dechocardiogram. The fistulas were seen on coronary angiogram. Only one patient underwent surgery but succumbed post operatively due to massive blood loss. The other 4 patients were stable on optimal medications and the 6th patient in the series died of hypovolemic shock secondary to alleged intra-abdominal ruptured vascular aneurysm.

Conclusions:

Due to its rarity and complexity, coronary vascular fistulas remain a challenge as to diagnostic approach, surgical intervention and continued medical management. It requires optimal use of multiple diagnostic imaging and multidisciplinary management, with long term follow up. As shown in this series, atherosclerosis and hypertension were common risk factors, highlighting the importance of its vascular sequelae other than the usual coronary artery disease. Hence, lifestyle and risk factor modifications remain vital.

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