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  • Title: Progressive coronary artery-pulmonary artery fistula after size-mismatch cardiac transplantation.
    Author: Matsubara TJ, Iwata H, Shiga T, Hatano M, Yao A, Ono M, Kinugawa K, Hirata Y, Nagai R.
    Journal: ASAIO J; 2011; 57(4):346-7. PubMed ID: 21508827.
    Abstract:
    Patients who have undergone cardiac transplantation are occasionally complicated by the development of a coronary artery fistula. It has been reported that a majority of coronary artery fistulas in a post-heart transplant setting communicate with the right ventricle. Moreover, most had a favorable prognosis and were rarely associated with hemodynamic disorder. In contrast, the present report describes a case with a progressive coronary artery fistula that drained into the pulmonary artery in a Japanese male who underwent size-mismatch orthotopic cardiac transplantation from a white male donor. The fistula gradually enlarged and a left-to-right shunt deteriorated over a 5-year period after transplantation. In this case, because the coronary fistula drained into the pulmonary artery, endomyocardial biopsy was not considered as a possible cause of the fistula. It is conceivable that size-mismatch heart transplantation may be associated with the development of fistula.
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