De Winter ECG Pattern Can Be A Temporary ECG Phenomenon Related To Severe Stenosis of The Left Circumflex Coronary Artery: A Case Report

The de Winter ECG pattern consisting of ST-segment depression and tall symmetrical T waves on ECG, known as an ST elevation equivalent, accounts for approximately 2% of patients with occlusion of the proximal left anterior descending coronary artery (LAD). These patterns are considered static and persistent and are, on average, recorded 1.5 hours after onset. Here, we describe a case of the de Winter ECG pattern as a temporary ECG phenomenon associated with left circumflex coronary artery (LCX) stenosis.

Left ventricular inflow obstruction due to a coronary arteriovenous fistula: a paediatric case report

Background We report a rare case of left ventricular inflow obstruction from a branch of the left circumflex coronary artery to the right atrium caused by a coronary arteriovenous fistula (CAVF) in a young Japanese male child. Case presentation The patient was diagnosed with CAVF following a heart murmur shortly after birth. The left-to-right shunt caused right ventricular volume overload and pulmonary congestion. An emergency surgical intervention was performed for the CAVF on day 6 after birth. However, by 5 years of age, his left ventricular inflow obstruction worsened. We found an abnormal blood vessel originating from the proximal part of a branch of the left circumflex coronary artery, circling the outside of the mitral valve annulus along the medial side of the coronary sinus. As the child gets older, the blood inflow into the left ventricle might get restricted further, resulting in left-sided heart failure. Conclusion Our findings suggest that even after CAVF closure surgery, it is essential to monitor for complications caused by progressive dilatation of a persistent CAVF.

Percutaneous closure of a fistula from the left circumflex coronary artery to the coronary sinus in an infant

Coronary artery fistula is an abnormal direct connection between the coronary artery and any of the four chambers of the heart or great vessels. A fistula from the left circumflex coronary artery to the coronary sinus is a relatively rare situation. We report a case of 12-month-old infant with coronary artery fistula from the left circumflex coronary artery to the coronary sinus that was identified incidentally. The N-terminal pro-brain natriuretic peptide level was elevated. Additionally, the proximal segment of the left circumflex coronary artery was dilated. On the basis of these findings, percutaneous closure of the fistula was performed with a vascular plug. This procedure achieved no residual flow and good hemodynamics were observed during follow-up.