demonstrated no left ventricularwall mo-
There have been
onlythree reporteda
cases in
fistula
ventricle.1-7
graphy
tion abnormalities.
weeks later showed
2
which
formed
Coronary angiography
coronary artery rupture
with the left or
a
LADand
a
patent
persistent
communicating
Although
of the
right
LAD-left ventricular fistula. The RCAlesion was
those cases demonstrated
a
perforation
dilated with
stent. Exercise thallium
a
3.0-mmPalmaz-Schatz
or mid
our
had
a
successfully
proximal
LAD,
patient
of the
branch. The
case
myocardial scintigraphy
perforation
septal
coronary
to arise
showed no evidence of
ischemia. The
myocardial
in the
perforation
present
appeared
had no further
patient
an-
from an
insertion of the
wire
symptoms. Coronary
inadequate
guide
5
months later revealed
into
a
small side branch of the first
giography performed
septal
closure of the fistula and
a
first
branch. The
of the balloon catheter caused
insertion and inflation
complete
patent
5A). Because in-stent
restenosis was noted in the
subsequent
branch
of the
into
septal
(Figure
disruption
small side
in
LAD, repeat angio-
with
branch, resulting
hemorrhage
with
a
3.0-mmballoonwas
the
wall and communication with the left
plasty
performed
septal
a
favorable outcome
5B).
ventricular
Serious
did not
(
Figure
cavity.
complications
occur in our
left-to-left shunt
because the fistula was
a
patient
diastole.
steal was not noted dur-
present mainlyduring
Furthermore, coronary
exercise
ing
testing.
Discussion
Iannone and Iannone~ first described
ventricular fistula
a coro-
nary artery-left
balloon
complicating
demonstrated
The incidence of
dur-
coronary artery perforation
angioplasty. Although they
balloon
is
low, and hemor-
a
dissection of the LADthat communicated with
ing
angioplasty
fairly
into the cardiac
a
the left
the
outcome of the
case, however,
spontaneously
rhage
cavity through
perfora-
ventricle,
long-term
tion is
rare. 1-3 Ellis et al3 classified
fistula wasnot mentioned. In our
the fistula was found to have
exceedingly
as three
extra-
coronaryperforation
types: type I,
luminal crater without extravasation;
closed within
5
months. Therefore, weconclude
type
II,
or
blush without contrast
that
treatment is not
pericardial
extravasation;
frank
myocardial
and
emergentsurgical
necessary
ventricular
III, extravasation
for an
type
through
iatrogenic coronary artery-left
fistula if distal
flow is
coronary
a
into an
perforation. Coronaryperforation
preserved.
anatomic chamberor into the
sinus was
coronary
classified as
a
subclass of
III.
type
are
Non-cavity
III
ac-
Takashi
MD
spilling type
perforations
frequently
Takenaka,
Division of
serious cardiac events such as car-
companied by
Cardiology
diac
In contrast,
is
the
National
tamponade.3>4
cavity spilling
Sapporo
Sapporo
Japan
Hospital
associated with non-fatal
003-0804
sequelae, including
3
creation of
a
fistula.3
coronary artery
References
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cutaneous transluminal
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