Coronary-to-bronchial artery communication: report of two patients successfully treated by embolization

Atypical chest pain due to multiple coronary arteries fistulas occluded with percutaneous interlock coils: A case report

Coronary artery fistulas, although rare, should be included in the differential diagnosis of atypical chest pain, generally unveiled by cardiac catheterization or multidetector computed tomography. Such anatomical findings in conjunction with detectable ischemia and severe symptoms should prompt their closure. Transcatheter closure of fistulas is an attractive alternative to surgery, especially with the novel devices such as the interlock fibered detachable coils, which can be safely and effectively performed in a variety of circumstances, including the coronary arteries with tortuous anatomies. We present a case of atypical chest pain and large burden of ischemia in the stress scintigraphy, due to multiple coronary fistulas to the bronchial arteries successfully occluded with percutaneous interlock coils. <Learning objective: This report describes the feasibility and safety of multiple tortuous coronary-bronchial fistulas treated with the novel interlock fibered detachable coils, in a patient with prior thromboembolism. This is the first case report to use this device in this situation and shows that, in symptomatic patients with documented ischemia, such novel devices may help in treating coronary fistulas, even in tortuous anatomy.>.

Takayasu Arteritis with Multiple Coronary Artery Fistulas to Bronchial Arteries

Takayasu arteritis (TA) is an inflammatory disease that commonly occurs in young females. Coronary involvement occurs rarely and mostly with stenosis. Here, we present a case of TA associated with fistulas between the coronary arteries and the bronchial arteries.

Acquired coronary-to-bronchial artery fistula after two valve surgeries

A 62-year-old woman with Takayasu arteritis and 2 prior aortic valve replacements, was admitted with unstable angina. Computed tomographic angiography showed a newly developed right coronary artery-to-right bronchial artery fistula. Because of dense aortic calcification, catheter embolization was undertaken, which was successful. We believe the acquired coronary artery fistula developed after her uneventful second aortic valve surgery, due to inevitable trauma to the mediastinum and ascending aorta, and partly due to her underlying Takayasu arteritis.

Bronchial artery hypertrophy is correlated with coronary artery disease

BACKGROUND

Bronchial arteries support the systemic pulmonary vasculature and physiologically communicate with pulmonary arteries and coronary arteries. While there is evidence supporting the link between pulmonary diseases and bronchial artery hypertrophy (BAH), few data on the correlation between coronary artery disease (CAD) and BAH have been published.

PURPOSE

To evaluate a possible association between BAH and CAD in patients without known pulmonary diseases undergoing computed tomography coronary angiography (CTCA).

MATERIAL AND METHODS

This retrospective study was approved by the local ethics committee. One hundred patients with varying degrees of CAD underwent CTCA. Patients were stratified into four groups as follows: group I, 25 patients without CAD or with non-significant CAD; group II, 25 untreated patients with significant CAD; group III, 25 stented patients; group IV, 25 patients with coronary artery bypass grafts. The number and diameter of bronchial arteries were recorded. Correlation between age, CAD, and BAH was estimated.

RESULTS

One hundred and ninety-nine bronchial arteries were detected. Approximately 51% were hypertrophic (diameter, >1.5 mm) with a mean diameter of 1.7 ± 0.5 mm. Seventy-six patients showed no pulmonary alterations; 24 were found to have previously undiagnosed pulmonary findings, six of which were severe. Presence and degree of CAD correlated with patients' mean age (60 in group I, 68 in group II, 65 in group III, 69 in group IV; P = 0.023), and mean bronchial artery transverse diameter (1.6 mm, 1.7 mm, 1.8 mm, and 2.0 mm, respectively; P = 0.009). The bronchial artery diameter was not associated with pulmonary findings (P = 0.390).

CONCLUSION

There is an association between CAD and BAH. In patients with no pulmonary alterations, BAH could be caused by undiagnosed underlying CAD.

Coronary artery-bronchial artery fistulas: report of two Dutch cases with a review of the literature

Background

Coronary bronchial artery fistulas (CBFs) are rare anomalies, which may be isolated or associated with other disorders.

Materials and methods

Two adult patients with CBFs are described and a PubMed search was performed using the keywords “coronary bronchial artery fistulas” in the period from 2008 to 2013.

Results

Twenty-seven reviewed subjects resulting in a total of 31 fistulas were collected. Asymptomatic presentation was reported in 5 subjects (19 %), chest pain (n = 17) was frequently present followed by haemoptysis (n = 7) and dyspnoea (n = 5). Concomitant disorders were bronchiectasis (44 %), diabetes (33 %) and hypertension (28 %). Multimodality and single-modality diagnostic strategies were applied in 56 % and 44 %, respectively. The origin of the CBFs was the left circumflex artery in 61 %, the right coronary artery in 36 % and the left anterior descending artery in 3 %. Management was conservative (22 %), surgical ligation (11 %), percutaneous transcatheter embolisation (30 %), awaiting lung transplantation (7 %) or not reported (30 %).

Conclusions

CBFs may remain clinically silent, or present with chest pain or haemoptysis. CBFs are commonly associated with bronchiectasis and usually require a multimodality approach to be diagnosed. Several treatment strategies are available. This report presents two adult cases with CBFs and a review of the literature.

Coronary to bronchial artery fistula causing massive hemoptysis in patients with longstanding pulmonary tuberculosis

We report on three cases of longstanding pulmonary tuberculosis patients with coronary to bronchial artery fistula (CBF) who presented with recurrent massive hemoptysis. The first and second patients died because of decreased functional pulmonary volume plus massive hemoptysis and cannulation failure of CBF due to hypovolemic vasospasm, respectively. When recurrent hemoptysis occurs despite successful embolization treatment, CBF should be considered as a potential bleeding source. Moreover, a coronary angiography should be performed, especially in patients with longstanding cardiopulmonary disease such as pulmonary tuberculosis.

Complex coronary artery fistulas in adults: evaluation with multidetector computed tomography

Coronary artery fistulas (CAFs) are rare congenital or acquired abnormalities that have anomalous terminations of the coronary arteries. Although many patients with CAFs are asymptomatic, they can display various clinical features associated with ischemic heart disease or heart failure. Making an early diagnosis is important for the proper management and prevention of late symptoms and complications. Conventional coronary angiography and cardiac CT have been commonly performed to diagnose CAFs, but multi-detector computed tomography (MDCT) is now being widely applied for diagnosing cardiovascular anomalies, and the number of incidentally detected CAFs on MDCT has been increasing. Therefore, we have to be familiar with the image findings of CAFs, and especially the image findings of MDCT for making the correct diagnosis of CAFs. In this article, we illustrate the MDCT findings of various types of CAFs in adults and we review the pathophysiology and clinical features of CAFs.

Transcatheter embolization of bronchial artery arising from left circumflex coronary artery in a patient with massive hemoptysis

It has been reported that anastomoses between the bronchial and the coronary arteries can become dilated and functional in certain diseases, provoking angina pectoris through coronary steal syndrome. The condition can be treated with endovascular or surgical management. It is possible that this abnormality may be associated with hemoptysis in patients with parenchymal or vascular disease of the lung but this condition is very rare. We present the coronary CT angiographic findings of bronchial arteries arising from the left coronary artery and their treatment with transcatheter embolization for the control of massive hemoptysis.

Coronary-to-bronchial artery fistula: demonstration by 64-multidetector computed tomography with retrospective electrocardiogram-gated reconstructions

OBJECTIVE

The aim of this study was to evaluate the incidence of coronary-to-bronchial artery fistula (CBF) and clinical significance in 1300 patients examined with 64-multidetector computed tomography (MDCT) coronary angiography.

METHODS

One thousand three hundred ten patients underwent coronary MDCT for atypical chest pain or screening. Volume-rendering and multiplanar reconstruction images were reviewed, and subsequent cineangiographies were compared.

RESULTS

Eight cases of CBF were detected-6 originated from the left circumflex artery, and 2 originated from the right coronary artery. A hypertrophied anomalous branch of left circumflex artery was observed in 1 case, and underlying bronchiectasis was noted. Seven cases had a thin-wall communicating vessel. Subsequent cineangiography revealed identical appearance with MDCT reconstruction images.

CONCLUSIONS

The incidence of CBF (0.61%) in this study is similar to those of a few cineangiographic studies in the literature. Our study showed that 64-MDCT coronary angiography is an accurate and noninvasive tool for detection of CBF.

Identification of a coronary-to-bronchial-artery communication with MDCT shows the diagnostic potential of this new technology: case report and review

Development and refinement of multidetector computed tomography (MDCT) has brought the potential to replace conventional coronary angiography with a noninvasive technique that has comparable spatial and temporal resolution with a single breath-hold. Although clinical use of MDCT has largely been confined to evaluation of atherosclerotic coronary artery burden and coronary artery anomalies, it can be applied to diagnosis of other problems concerning the thoracic vasculature. We present the case of a middle-aged man who presented with recent-onset exertional angina: 64-detector CT was used as an alternative to cardiac catheterization and identified the underlying anatomic anomaly, a rare coronary-to-bronchial-artery communication. Clinicians should be aware that the newest generation of MDCT equipment may allow many patients to forego diagnostic cardiac catheterization without compromise in quality of care.

Coronary-to-bronchial anastomosis: an unusual cause of hemoptysis

Coronary-to-bronchial anastomosis (CBA) is a rare anomaly. This vascular abnormality may be subclinical or be responsible for several pathophysiological events and symptoms involving the respiratory and/or the coronary system. We report the case of a patient with hemoptysis caused by this anomalous coronary-to-bronchial communication, who was concomitantly affected by aortic stenosis and coronary artery disease requiring surgical treatment. A coronary angiogram clearly demonstrated the abnormal vascular connection between the proximal right coronary artery and the bronchial arteries of the left inferior right lobe. The coronary branch was intra-operatively identified and ligated, in association with aortic valve replacement and coronary artery bypass, with an uneventful postoperative course and resolution of the respiratory symptoms. This case presents an unusual cause of hemoptysis due to CBA in patients with other cardiac comorbidities, which required surgical treatment, allowing direct ligation of the CBA. A review of the clinical and therapeutic characteristics of such a peculiar vascular abnormality is also provided.

When, Why, and How to Examine the Heart During Thoracic CT: Part 2, Clinical Applications

OBJECTIVE

CT examination of the thorax is often requested for the investigation of disorders that may have an important underlying cardiac cause or association that is not clinically obvious. Conditions such as idiopathic and acquired cardiomyopathy, ischemic heart disease, and valvular dysfunction may underlie symptoms such as dyspnea, chest pain, and hemoptysis that prompt the request for CT of the thorax. Other conditions such as pulmonary thromboembolic disease, chronic obstructive airways disease, pectus excavatum, sleep apnea, and many intrathoracic malignancies may have an important effect on cardiac structure and function. Patients undergoing thoracic surgery may have unsuspected coronary artery disease that can be detected in the course of preoperative evaluation by CT; similarly, postoperative complications often have a cardiogenic basis.

CONCLUSION

Examination of the heart in the course of CT of the chest often can provide important and clinically relevant information that is not otherwise easily available.

Acquired coropulmonary and bronchopulmonary anastomoses occurring in association with pulmonary arterial occlusion and veno-occlusive disease generating potential coronary steal

The development of collateral circulation is a general vascular response which is well characterised in the heart. The most common precipitant of this is ischaemia and the most common manifestation is intra coronary collateralisation. Collateral flow between the heart and other thoracic structures is also documented albeit rarely and can be congenital or acquired. In this case report we define a unique case of collateral flow between the coronary and pulmonary circulations in a complex case of mediastinal fibrosis.