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Date of last update: 10/20/2017.

Forum Name: Congenital Heart Disease in Adults

Question: Coronary Artery Fistulas

 klasiu - Fri Mar 09, 2007 8:44 pm

Hello, I am a 35 year old female in relatively good health. I take no medications other than Topamax for migraine prophylaxis. I had open heart surgery on May 8, 2006 to ligate a RCA to LV Coronary Artery Fistula which was misdiagnosed when I was a child as a heart murmur. I developed a cardiac tamponade, which required a second surgery on May 13, 2006. After being released from the hospital, I developed an infection in my incision (which was caught early and taken care of with antibiotics), I then caught pneumonia which was also treated with a course of antibiotics. My sternal incision has formed a keloid scar, for which I have received injections of kenalog to minimize the pain & itch(3 injections to date). I was recently (1/23/07) hospitalized for chest pains and had several tests. The cardiac cath done prior to CAF ligation revealed no blockages, but the tests done during the Jan 2007 hospital stay were as follows: ECG returned an inferior infarct, X-rays revealed an enlarged heart, nuclear stress test indicated probable issues with front & back of heart. The doctors also suspect that my sternum hasn't fully healed due to the rocking and crunching that happens when they palpate my chest. One of the cardiologists I saw recommended that I undergo another cardiac cath. I was hesitant due to the complications I had following the surgery - especially since the cardiologists seem unsure of what may be causing my symptoms (and test results) and a general concensus that issues with my sternum could be causing a majority of my problems - ECG and Stress test results notwithstanding.

Due to the differences in opinion on how to proceed, I traveled to another island (I'm in Hawaii) to obtain yet another opinion. I was advised that I could choose to have a 64 slice CTA scan performed in lieu of another cardiac cath for the time being; then, if the CTA scan indicates a problem, I could have another cardiac cath performed. My quandary is that while my insurance will cover a cardiac cath, it will not cover a CTA scan. I would gladly pay for the CTA out of pocket if this will accurately diagnose what is causing the chest pains; however, if I will have to eventually undergo a cardiac cath anyway, I would rather skip the CTA even though I am hesitating to go with another invasive procedure. Any advice would be appreciated!
 Dr. Yasser Mokhtar - Fri Mar 16, 2007 4:50 pm

User avatar Dear klasiu,

Personally, i don't think that the pain that you have is related to coronary disease, because i don't think it is possible to have coronary artery diseasr develop over this short time period.

However, if your doctor suggested that you get another cardiac cath done based on the available information, i think you should go ahead and get it done, even if you just have it to have the peace of mind.

Every time, you have to have a procedure done of course, you have to weigh the risks and the benefits of the procedure, before deciding whether or not you want the procedure done.

Thank you very much for using our website and I hope that this information helped.

Yasser Mokhtar, M.D.
 Marceline F, RN - Sat Mar 17, 2007 12:50 am

User avatar Dear Klasiu,
WOW, seems like you have had more than your share of problems for your young age! There are several things I would like to address from my professional experience. First of all, a heart murmur is a sound. The etiology of the murmur might not be caught for many years, usually until the individual becomes symptomatic, or there develops a need for diagnostics based perhaps on need for health insurance changes or job requirements. It is unfortunate that the surgery you had led to so many post "complications". The cardiac tamponade could certainly have contributed to an inferior wall MI. Review of your clinical history perioperatively might reveal that your heart experienced an injury that showed in your later stress test as "probable issues with front and back of heart". It is indeed unlikely that new plaque or lesions developed between your initial cath (clean coronaries) and the later chest pain, even though I suppose nothing is totally impossible. It is also remotely posible that surgical scarring could account for some mechanical stenosing of coronary veins and arteries.
Regarding your sternum: The infection in your incision could have contributed to an unstable sternum. Sternal wound infections have been known to end up with complications in the sternum itself. Personally, I doubt that the MD assessments contributed to the problem, the sternum is typically wired together post OHS, and unless you are the unfortunate recipient of CPR, standard palpations do not rock or crunch the chest.
You express a concern about a repeated invasive cardiac catheterization. CTA (computed tomographic angiography) is an excellent method of non-invasively determining existing cardiac vessel disease. Used as an adjunct to other diagnostic tests, it may help you determine need to do another interventional CC. It certainly would be well worth your time to discuss this further with your trusted cardiologist.

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