Case Reports in Medicine

Case Reports in Medicine / 2009 / Article

Case Report | Open Access

Volume 2009 |Article ID 840904 | 2 pages | https://doi.org/10.1155/2009/840904

Moyamoya Disease with Peripheral Pulmonary Artery Stenoses and Coronary Artery Fistulae

Academic Editor: Omer Faruk Dogan
Received14 Feb 2009
Accepted07 May 2009
Published27 May 2009

Abstract

Moyamoya is a progressive disorder of the cerebral vasculature. Our report describes a rare case of Moyamoya disease with distal peripheral pulmonary artery stenoses and coronary fistulae in a 12-year-old Caucasian female patient.


A 12-year-old Caucasian female with known Moyamoya was admitted for hemodynamic and angiographic evaluation of increasing dyspnea and exertional chest pain. Echocardiogram indicated elevated right ventricular pressure. The patient had initially presented one year previously with acute onset of neurological symptoms, which included dysarthria and involuntary movements. Her developmental history to that point had been entirely normal. A Computed Tomography angiogram demonstrated severe narrowing of the cervical and intracranial carotid arteries bilaterally, consistent with an advanced Moyamoya pattern. Pial synangiosis was performed with a subsequent improvement in her symptoms.

At cardiac catheterization she was shown to have an elevated pulmonary artery pressure (75/18 mmHg, mean 36). Angiography showed that the right coronary artery was patent, and there were two fistulae (Figure 1). The fistulae (indicated by arrows) appear to connect the proximal right coronary artery to the right atrium and the mid vessel to the small cardiac vein. Pulmonary angiography revealed extensive distal peripheral arterial stenoses and areas of pulmonary hypovascularity (Figure 2). Left and right magnetic resonance carotid and cerebral angiography demonstrated marked attenuation of the right internal carotid artery and occlusion of the left internal carotid artery (Figure 3).

Moyamoya is a rare progressive disorder of the cerebral vasculature characterized by bilateral carotid artery occlusive disease that was first described in 1957 (Figure 3) [1]. The resulting dense abnormal collateral vascular network at the base of the brain has the angiographic appearance of a “puff of smoke” or, in Japanese, “moyamoya.” Arterial involvement of the renovasculature occurs in 5% of cases [2]. There are limited reports of involvement of the coronary and pulmonary circulation. Epicardial coronary artery stenoses may occur, and one case describes right coronary artery to right ventricular fistulae in a 56-year-old male [3]. Another one reports systemic and pulmonary hypertension in a child with Moyamoya disease [4]. Our case is a rare description of Moyamoya disease with distal peripheral pulmonary artery stenoses and coronary fistulae in a young female patient.

References

  1. K. Takeuchi and K. Shimizu, “Hypogenesis of bilateral internal carotid arteries,” No To Shinkei, vol. 9, pp. 37–43, 1957. View at: Google Scholar
  2. O. Togao, F. Mihara, T. Yoshiura et al., “Prevalence of stenoocclusive lesions in the renal and abdominal arteries in moyamoya disease,” American Journal of Roentgenology, vol. 183, no. 1, pp. 119–122, 2004. View at: Google Scholar
  3. G. Gatti, B. Benussi, L. Gon, and B. Zingone, “Aortic valve replacement in an adult white male with moyamoya disease and coronary artery fistulas,” Journal of Cardiothoracic and Vascular Anesthesia, vol. 21, no. 1, pp. 166–168, 2007. View at: Publisher Site | Google Scholar
  4. P. Ou, P. Dupont, and D. Bonnet, “Fibromuscular dysplasia as the substrate for systemic and pulmonary hypertension in the setting of Moya-Moya disease,” Cardiology in the Young, vol. 16, no. 5, pp. 495–497, 2006. View at: Publisher Site | Google Scholar

Copyright © 2009 Lindsay Reardon et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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