AUCTORES
Globalize your Research
Case Report | DOI: https://doi.org/10.31579/2690-8808/190
Cardiovascular Center, Onze Lieve Vrouwziekenhuis (OLV), Aalst, Belgium
*Corresponding Author: Marc Vanderheyden, MD Cardiovascular Center, OLV Ziekenhuis, Moorselbaan 164, 9300 Aalst, Belgium.
Citation: Augustijn Mortele, Marta Belmonte, Eline Bogaerts, Marc Vanderheyden, (2024), Bilateral Coronary Artery Fistulas and Pulmonary Sequestration. An Unusual Combination of a Rare Disease: Case Report and Review of the Literature. J, Clinical Case Reports and Studies, 5(2); DOI:10.31579/2690-8808/190
Copyright: © 2024, Marc Vanderheyden. 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.
Received: 19 March 2024 | Accepted: 08 April 2024 | Published: 26 April 2024
Keywords: coronary artery fistulas; pulmonary sequestration; coronary vessel anomalies; diagnosis
Coronary artery fistulas are a rare entity, especially when they origin from both the left and right coronary arteries. CAF may be asymptomatic but severe complications are possible. They are usually congenital but acquired forms have been described. The management of CAF remains undetermined and depends on various factors. Pulmonary sequestration is another rare congenital malformation. It is a non-functioning lung segment without continuity with the normal lung parenchyma.
In this case report an 83-year-old male with newly diagnosed idiopathic pulmonary fibrosis, history of ischemic cardiomyopathy and severe tricuspid regurgitation was admitted for syncope. Due to episodes of non-sustained ventricular tachycardia an invasive coronary angiography was ordered which showed 2 coronary artery fistulas. The two CAF, arising respectively from the right coronary artery and the left anterior descending artery, both supplied blood to vessels in a sequestrated segment of the lower lung lobe.
This is the first report of two coronary artery fistulas, arising from both left and right coronary artery, providing blood supply to a pulmonary sequester. Although this entity is extremely rare, knowledge of it can prevent inappropriate management and fatal results.
CAF: coronary artery fistula
CCA: conventional coronary angiography
CTA: coronary CT angiography
CPAF: coronary artery-to-pulmonary artery fistula
IPF: idiopathic lung fibrosis
PCI: percutaneous coronary intervention
LAD: left anterior descending artery
RCA: right coronary artery
LV: left ventricular
EF: ejection fraction
RV: right ventricular
TR: tricuspid regurgitation
ERO: effective regurgitant orifice
FAC: fractional area change
TAPSE: tricuspid annular plane systolic excursion
HRCT: high-resolution CT scan
FFR: Fractional flow reserve
TC: transcatheter closure
Coronary artery fistulas (CAF) were first described in 1865 [1] and are rare vascular anomalies characterized by abnormal connections between coronary arteries and structures such as the heart cavity, pulmonary circulation, coronary sinus, or vena cava. [2-4] Usually congenital, acquired forms have also been reported. [5,6] The clinical presentation of CAF varies based on the shunt's location, size, and associated conditions. [3,7]
Conventional diagnostic techniques like coronary angiography (CCA) provide limited insights into the 3D anatomy and tissue interactions. In contrast, coronary CT angiography (CTA) is a superior alternative. CTA offers improved visualization of the fistulas' origin, drainage, number, and can detect aneurysms, thrombi and intricate vascular details. [8] Routine CTA has revealed a prevalence of 0.9% for CAF, with coronary artery-to-pulmonary artery fistula (CPAF) being the most common, followed by coronary artery-to-bronchial artery fistula and coronary artery-to-cardiac chamber fistula. [5] They more frequently arise from the right coronary artery (50%) than the left coronary artery (42%), and in about 5% of cases, they originate from both arteries. [9] CAF may remain asymptomatic or cause symptoms such as chest pain or dyspnea related to a steal phenomenon. [4] In rare cases, complications may occur, including massive hemoptysis, pulmonary hypertension, congestive heart failure, or arterial aneurysm rupture. [4,6,7] CAF can co-occur with lung-related diseases such as bronchiectasis, pulmonary tuberculosis, cystic fibrosis, chronic bronchitis, and interstitial fibrosis. [3,5,7,10] In extremely rare cases, CAF may supply blood to a sequestrated lung segment. [11] Treatment of CAF varies, depending on size, symptoms, anatomical characteristics, concomitant disorders, and the patient's age. Management strategies range from a "watchful waiting" approach to antiplatelet therapy, antibiotics and surgical or percutaneous closure. [4,12] The purpose of this article is to review the literature on CAF, focusing on an exceptional case report.
An 83-year-old male non-smoker (with no known exposure to any occupational hazards) diagnosed with idiopathic lung fibrosis (IPF), treated with antifibrotic medication, and having undergone a proximal LAD PCI due to unstable angina, was referred for evaluation of recurrent syncopal episodes. These episodes occurred at rest, characterized by sudden loss of consciousness and quick recovery. They were unexplained and did not involve palpitations. Previous investigations, such as long-term holter monitoring, EEG, brain CT scan and carotid artery duplex were inconclusive. The patient's medication regimen included Spironolactone 100 mg, Bumetanide 2 mg, and Perindopril 5 mg, initiated due to heart failure with mid-range ejection fraction (HFmrEF) caused by ischemic cardiomyopathy.
Upon admission, the patient's cardiopulmonary examination appeared normal with an oxygen saturation of 96%. Bilateral inspiratory crepitations were heard during lung auscultation. Electrocardiography (ECG) revealed permanent atrial fibrillation with a ventricular rate of 67 beats per minute. Blood tests showed no abnormalities. Transthoracic echocardiography revealed mildly reduced left ventricular (LV) function with an ejection fraction (EF) of 45%, due to post-ischemic hypokinesia of the anterior wall and apex. The right ventricle (RV) appeared moderately dilated, with functional moderate tricuspid regurgitation (TR) with an effective regurgitant orifice (ERO) of 35 mm2 and a peak TR velocity of 3.2 m/sec. The RV had a tricuspid annular plane systolic excursion (TAPSE) of 13 mm and a systolic velocity (s') of 9 cm/sec, with an RV fractional area change (FAC) of 30%. Additionally, D-shaping of the RV was observed.
Chest X-rays showed reticular interstitial markings near the lung bases, while high-resolution CT scans (HRCT) confirmed the presence of IPF. The HRCT revealed fibrotic changes in both lung bases and peripheries, characterized by patchy reticular opacities and honeycombing.
Non-sustained ventricular tachycardia episodes during hospitalization led to a coronary catheterization showing normal coronary arteries with minimal atherosclerosis and a patent stent in the LAD. Fractional flow reserve (FFR) measurements were conducted to rule out ischemia in the LAD territory as the underlying cause of the ventricular arrhythmias. Simultaneously, a right heart catheterization was carried out revealing a mean pulmonary arterial pressure of 25 mmHg, pulmonary arterial systolic pressure of 45 mmHg, a mean pulmonary capillary wedge pressure of 20 mmHg, and a pulmonary vascular resistance of 1 WU.
Two coronary artery fistulas (CAFs) were identified: one originating from the distal RCA (Movie 1, Figure 1) and the other from the LAD (Movie 2, Figure 1, 2), proximal to the implanted stent. Both CAFs supplied blood to vessels in a secluded part of the lower lung lobe (Figure 1-2).
Panel A: Right anterior oblique view of the CAF originating from the right coronary artery.
Panel B: Right anterior oblique view of the CAF originating from the left anterior descending artery.
Figure 1: CCA images from both CAF
Upper left image: Coronal oblique view derived from CTA – The coronary-pulmonary fistula originates from the proximal left anterior descending artery (white arrowhead).
Upper right and mid images: 3D reconstruction of the CAF. The path of the fistula is illustrated with white arrowheads, while yellow arrowheads indicate the presence of a pulmonary sequestration.
Lower images: Set of axial views derived from CTA The path of the fistula is illustrated with white arrowheads, while dashed white arrowheads indicate the stent in the proximal LAD
Ao indicates aorta, x pulmonary sequester
Figure 2. CTA images from the left sided CAF.
Movie 1.
CCA movie illustrating CAF originating from the right coronary artery (right anterior oblique projection).
Movie 2.
CCA movie demonstrating CAF originating from the left anterior descending artery (right anterior oblique projection).
A retrospective analysis of the coronary angiogram performed during the PCI confirmed the presence of these CAFs, ruling out any connection to iatrogenic dissection or complications related to the PCI. Furthermore, the morphology of these CAFs appeared to be unchanged.
Because the patient's syncope could not be attributed to the CAFs, and an electrophysiological study revealed no abnormalities except for the pre-existing permanent atrial fibrillation and normal HV conduction, an observational approach was undertaken with the implantation of a loop recorder. After one month, a decision was made to implant a VVI pacemaker due to the documentation of a ventricular pause lasting over 3 seconds, despite the absence of symptoms, and the patient's history of unexplained and recurrent syncopal episodes. Initially, the patient's condition showed improvement, and there were no further instances of syncope following pacemaker implantation. However, two years later, he passed away because of respiratory failure caused by SARS-CoV-19 infection.
In this case report we describe a rare case of congenital asymptomatic bilateral coronary artery fistulas feeding a pulmonary sequester in a patient with idiopathic pulmonary fibrosis. Although coronary artery fistulas arising from both the right and left coronary artery are well described and certain types of CAF have been associated with abnormalities in the lung parenchyma or pulmonary vasculature, the co-existence of 2 CAFs originating from both left and right coronary artery and feeding a pulmonary sequester is extremely rare and has to the best of our knowledge never been described. [5,9]
Various hypotheses explain the embryogenesis of CAF. The most widely accepted one is the Hackensellner involution-persistence hypothesis. This hypothesis states that only two of the six branches of the truncus persist and form the coronary arteries, while the other four involute. CPAF develop when there is an abnormal persistence of the branch from the pulmonary sinus that connects to the normal branches forming the coronary arteries. [13]
Another hypothesis suggests the presence of congenital, small, non-functional anastomoses between the bronchial arteries and the coronary arteries that grow and enlarge due to several factors. This may occur when there is a shunting of blood from the coronary to the bronchial circulation, for example, in the presence of a supravalvular aortic stenosis causing increased coronary artery pressure or when the bronchial artery pressure drops, for example, in pulmonary atresia. Similarly, in obstructive coronary artery disease, the fistula may fill the coronary artery distal to the obstruction. [7]
CAF can be acquired and have been documented after a myocardial infarction or penetrating trauma. Recurrent inflammation, observed in bronchiectasis, may stimulate angiogenesis and the formation of an acquired CAF. [14] In this case, CAFs were already present five years before the diagnosis of idiopathic pulmonary fibrosis (IPF) at the time of a percutaneous coronary intervention (PCI). This timeframe makes it less plausible to establish a causal relationship between the two conditions.
There are no prospective randomized trials comparing the various management options, and all recommendations are based on small retrospective series. The management strategy is influenced by multiple factors, such as the size and anatomy of the CAFs, presence of symptoms, associated cardiovascular abnormalities, patient's age and comorbidities. [10,13]
Small CAFs tend to close on their own over time, so a monitored approach is usually sufficient. The choice between transcatheter closure (TC) and surgical intervention is still debated. However, with advancements in transcatheter equipment and techniques, TC has become the preferred method for closure of CAFs. Specifically, for patients with favorable anatomy (single narrow drainage site, proximal fistula origin, absence of multiple fistulas or large branch vessels) and no concomitant cardiac disorders, TC is now considered the first choice. [15]
Despite being less invasive, TC is not without complications such as residual leakage or recanalization of the fistulas, coil migration, thromboembolism and distal embolization. Therefore, it is recommended to thoroughly evaluate both the CAFs and the patient before starting therapy. [13]
In this case, the discovery of a pulmonary sequestration was incidental. Thanks to the normal FFR value, which ruled out a connection between coronary steal and ventricular rhythm issues, a conservative approach was chosen. [4,12]
Coronary artery fistulas remain a remarkable entity with many unanswered questions about its pathophysiology, natural history and treatment. It is important to acknowledge their existence and detect possible complications to facilitate the most optimal, patient-tailored management. In a patient with sequestration, suspicion of coronary origin is important and requires preoperative angiography when surgical ligation of the feeding artery is considered. Injury or proximal ligation may produce myocardial ischemia, infarction or death. Although this entity is extremely rare, knowledge of it can prevent inappropriate management and fatal results.
The main limitation of this study is its inability to generalize the findings beyond the specific case being reported. Therefore, the use and interpretation of these results should be approached with caution and considered within a broader context.
AM, MV contributed to the conception and writing of the manuscript. All authors contributed to manuscript revision, read and approved the submitted version.
Conflicts of Interest: none declared.
Funding Statement: none declared.
Patient Consent Statement
We declare that an informed consent, in compliance with COPE guidelines, has been obtained from the involved patient and that the patient has given approval for the information to be published in this case report.
Author Data
The data underlying this article are available in the article and in its online supplementary material. We have no conflicts of interest to disclose.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
