Cases reported "Heart Murmurs"

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11/41. Fistulous connection between internal mammary graft and pulmonary vasculature after coronary artery bypass grafting: a rare cause of continuous murmur.

    A 58-year-old male who had undergone coronary artery bypass grafting (CABG) using left internal mammary artery and a sequential saphenous vein graft 2 years ago presented with new onset angina. His initial physical examination revealed an unexpected continuous murmur over the left sternal border, and two-dimensional echocardiography has failed to identy the cause. cardiac catheterization then performed and revealed patent left internal mammary artery and saphenous vein grafts. Besides, selective injection of the left internal mammary artery graft also showed a fistula formation between left internal mammary artery graft and pulmonary vasculature of the left upper lobe. He was managed conservatively because of the severely diseased left anterior descending artery distal to internal mammary artery anastomosis and low pulmonary artery pressure. The development of fistulous connection between internal mammary artery and pulmonary vasculature is an extremely rare complication following CABG. patients with such fistulae usually present with chest pain due to coronary steal syndrome. A new heart sound, especially a continuous murmur, may be detected during physical examination. Surgical correction is indicated in the event of refractory angina, growing fistula causing heart failure or endarteritis. Otherwise, a conservative approach with instruction of the patient for prophylactic precautions of subacute bacterial endocarditis may be recommended for asymptomatic patients.
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ranking = 1
keywords = fistula
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12/41. Venous oxygen embolism produced by injection of hydrogen peroxide into an enterocutaneous fistula.

    We report a venous oxygen embolism that occurred in a 66-yr-old man after 60 mL of 3% hydrogen peroxide was injected into a perianal fistula intraoperatively to locate its internal opening. The diagnosis was made after detecting hypoxemia, decreased end-tidal carbon dioxide tension, systemic hypotension, increased central venous pressure, and a new heart murmur. The patient recovered quickly and had no long-term sequelae. oxygen embolism is a potentially fatal complication that can develop when hydrogen peroxide is used near venous spaces, and clinicians should be aware of the potential dangers when using this seemingly innocuous chemical.
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ranking = 1.6666666666667
keywords = fistula
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13/41. Usefulness of selective contrast echocardiography and selective scintigraphy for the evaluation of pulmonary arteriovenous fistula in a patient with systemic arterial supply to a normal lung.

    To determine a surgical procedure for the correction of a systemic arterial supply to a normal lung, it is important to evaluate whether the patient has a pulmonary arteriovenous fistula. In this article, the authors report for the first time a patient in which selective contrast echocardiography and selective perfusion scintigraphy from an abnormal artery clearly demonstrated and quantified the pulmonary arteriovenous fistula. The authors believe that these methods are useful in determining the appropriate operative procedure for this condition.
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ranking = 2
keywords = fistula
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14/41. Accessory mitral valve in an adult population: the role of echocardiography in diagnosis and management.

    Accessory mitral valve is a rare congenital abnormality and is an unusual cause for subvalvular left ventricular outflow tract (LVOT) obstruction. It is detected first in children and is very rarely noticed in adults. The most common clinical presentation is symptomatic LVOT obstruction. We present a case series of 5 adult patients with varying clinical presentations in which the accessory mitral valve was diagnosed using echocardiography. Three patients presented with varying degrees of symptomatic LVOT obstruction, one presented with recurrent transient ischemic attack and stroke, and one patient was incidentally diagnosed during echocardiography to exclude endocarditis. Accessory mitral valve should be suggested in patients with LVOT obstruction.
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ranking = 0.00024394225679201
keywords = dental
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15/41. A continuous murmur.

    A 61-year-old male with a history of a mechanical Bjork-Shiley aortic valve replacement in 1977 and repair of an ascending aortic root dissection in 1993, presented with a 2-week history of fatigue and exertional dyspnea. echocardiography confirmed the presence of an aortic pseudoaneurysm with a fistulous connection between the aorta and right atrium, which subsequently underwent successful repair. Although there have been several cases describing the development of an aortic pseudoaneurysm after aortic dissection repair, our case is the first to describe an aorta-atrial fistula as a long-term complication of a previous aortic dissection repair.
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ranking = 0.33333333333333
keywords = fistula
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16/41. Giant congenital coronary artery fistula to left brachial vein clearly detected by multidetector computed tomography.

    Coronary artery fistulas (CAF) are a rare anomaly in which there is communication between a coronary artery and a cardiac chamber or another vascular structure. A giant congenital CAF to the left brachial vein was identified clearly by multidetector computed tomography (MDCT) in an 84-year-old woman who presented with orthopnea and continuous murmur. Electrocardiogram was almost normal, but chest X-ray showed marked cardiomegaly with pulmonary congestion. Transthoracic echocardiography showed that the wall motion of the left ventricle (LV) was normal, but with an abnormal cavity behind the LV. CAF was suspected and coronary angiography revealed that the CAF originated from the right coronary artery (RCA), connected to the giant vessel. However, because the drainage site was not clearly detected, MDCT was performed and it became clear that the CAF originated from the RCA. The left circumflex artery flowed into the giant vessel, and drained to the left brachial vein.
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ranking = 1.6666666666667
keywords = fistula
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17/41. Three major coronary artery-to-left ventricular fistula: an unusual cause of a diastolic murmur at the apex.

    Coronary artery fistula involving all the 3 major coronary arteries and emptying into the left ventricle is rare. We report an asymptomatic patient with coronary artery fistula from the 3 major coronary arteries communicating with the left ventricle, who presented with a diastolic murmur at the apex.
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ranking = 2
keywords = fistula
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18/41. An arterial duct associated with a congenital anomaly of the coronary arteries: persistence of a murmur after ligation of the duct.

    A patient is described in whom a persistent murmur was detected after surgical ligation of an arterial duct. Subsequently, she underwent investigation and was found to have associated rare congenital anomalies of a coronary arterial fistula and a single coronary artery.
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ranking = 0.33333333333333
keywords = fistula
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19/41. A patient with an arteriovenous fistula between the internal mammary artery and the pulmonary artery.

    A case of arteriovenous fistula between the internal mammary artery and the pulmonary artery was presented. In a recent review of the literature only 19 cases of this abnormality were described. In most instances, patients had continuous precordial murmur that might be confused with a patent ductus arteriosus. Definitive diagnosis was enabled by selective angiography.
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ranking = 1.6666666666667
keywords = fistula
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20/41. An arteriovenous fistula from an aberrant right subclavian artery to the superior caval vein in a congenitally myxoedematous adult.

    A 52-year-old woman with congenital myxoedema presented with congestive heart failure and a continuous heart murmur. On cardiac catheterization, an aberrant right subclavian artery was found which supplied an arteriovenous malformation. Her heart failure, however, was secondary to concomitant severe aortic regurgitation which was clinically masked by the signs of the fistula. To our knowledge, a congenital arteriovenous malformation arising from an aberrant subclavian artery has not been reported in the adult.
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ranking = 1.6666666666667
keywords = fistula
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