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Khalil G, Elbadri A, Abbasi SH, Das I, Ladwiniec A. An unusual cause of acute coronary syndrome: thrombosis of right coronary artery to right atrium fistula. BMJ Case Rep 2023; 16:e257368. [PMID: 38160024 PMCID: PMC10759029 DOI: 10.1136/bcr-2023-257368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Coronary arterial fistulae are rare, but it is one of the most common coronary artery anomalies. Most of the cases are asymptomatic in younger patients unless it is large and of haemodynamic significance. The incidence of thromboembolic complications usually increases with age. We report a case of a young male in his early 20s presenting with central chest pain. Coronary computed tomographic angiography revealed acute coronary syndrome due to a fistula between right coronary artery and right atrium occluded by thrombus. After discussion with coronary and congenital heart multidisciplinary team, a consensus was agreed that we should manage him conservatively with anticoagulant and antiplatelet therapy and a 3-month follow-up strategy that included repeating cardiac imaging. After a year, his anticoagulation and antiplatelet medication was discontinued.
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Affiliation(s)
- Ghayyur Khalil
- Kettering General Hospital, Kettering, Northamptonshire, UK
| | - Azza Elbadri
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Indrajeet Das
- University Hospitals of Leicester NHS Trust, Leicester, UK
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Shah L, Kundapur D, Nosib S. Stolen from the coronaries: Left-to-Left shunts presenting as chest pain syndrome! BMJ Case Rep 2021; 14:e242425. [PMID: 33762294 PMCID: PMC7993208 DOI: 10.1136/bcr-2021-242425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2021] [Indexed: 11/03/2022] Open
Abstract
We present the case of a 61-year-old woman with chest pain syndrome. Cardiac catheterisation did not reveal atherosclerotic coronary disease. However, a haemodynamically significant fistula connecting the left coronary artery to the left atrial appendage was found to be the culprit through a left-to-left shunting mechanism. In this report, we review the pathophysiology of coronary artery fistulas and the mechanism by which these fistulas may lead to 'coronary steal syndrome'. Indications for interventional and surgical management are outlined. Ultimately, we suggest the consideration of coronary artery fistulas in the differential diagnosis of patients presenting with chest pain.
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Affiliation(s)
- Love Shah
- Internal Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Deeksha Kundapur
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Shravan Nosib
- Cardiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Shrestha BK, Arora D, Mehta Y, Bhan A. Coil Migration After Endovascular Closure of a Coronary Artery Fistula. J Cardiothorac Vasc Anesth 2019; 34:184-186. [PMID: 31395413 DOI: 10.1053/j.jvca.2019.07.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 07/05/2019] [Accepted: 07/09/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Battu Kumar Shrestha
- Institute of Critical Care and Anesthesiology, Medanta the Medicity, Gurugram, Haryana, India
| | - Dheeraj Arora
- Institute of Critical Care and Anesthesiology, Medanta the Medicity, Gurugram, Haryana, India
| | - Yatin Mehta
- Institute of Critical Care and Anesthesiology, Medanta the Medicity, Gurugram, Haryana, India.
| | - Anil Bhan
- Department of Cardiac Surgery, Medanta Heart Institute, Gurugram, Haryana, India
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Said SAM. Congenital coronary artery fistulas complicated with pulmonary hypertension: Analysis of 211 cases. World J Cardiol 2016; 8:596-605. [PMID: 27847561 PMCID: PMC5088366 DOI: 10.4330/wjc.v8.i10.596] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 03/26/2016] [Accepted: 08/08/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To compare the behavior of pulmonary hypertension (PHT) associated with coronary artery fistulas (CAFs) between the Asian and Caucasian subjects.
METHODS CAFs may be complicated with PHT secondary to left-to-right shunt. Literature review limited to the English language. A total of 211 reviewed patients were collected. Of those, 111 were of Asian and 100 were of Caucasian ethnic origin. The mean age of the Asian and the Caucasian groups of patients were 48.9 (range 19-83) and 49.9 years (range 16-85), respectively. In both groups, right heart catheterization was the most commonly (95%) used method for determining pulmonary artery pressure.
RESULTS From all of the reviewed subjects, PHT was found in 49 patients (23%), of which 15 were Asian and 34 were Caucasian. In 75% of PHT subjects, mild to moderate PHT was reported and 76% of the fistulas had a vascular mode of termination. Treatment was surgical in 61%, followed by percutaneous therapeutic embolization (27%) and finally conservative medical management in 12% of PHT subjects. PHT was associated with a slight female gender predominance. The majority demonstrated mild to moderate PHT. PHT was reported more frequent in the Caucasian compared with the Asian ethnicity group. The majority of fistulas in patients with PHT had a vascular mode of termination. The results of this review are intended to be indicative and require cautious interpretation.
CONCLUSION The likelihood for a CAF patient to develop PHT is presented when possessing the following features, with a Caucasian female having a fistula with a vascular mode of termination.
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Challoumas D, Pericleous A, Dimitrakaki IA, Danelatos C, Dimitrakakis G. Coronary arteriovenous fistulae: a review. Int J Angiol 2014; 23:1-10. [PMID: 24940026 DOI: 10.1055/s-0033-1349162] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Coronary arteriovenous fistulae are a coronary anomaly, presenting in 0.002% of the general population. Their etiology can be congenital or acquired. We present a review of recent literature related to their epidemiology, etiology, pathophysiology, clinical presentation, diagnostic approach, and therapeutic management.
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Affiliation(s)
- Dimitris Challoumas
- School of Medicine, Cardiff University, Heath Park Campus, Cardiff, United Kingdom
| | - Agamemnon Pericleous
- School of Medicine, Cardiff University, Heath Park Campus, Cardiff, United Kingdom
| | | | | | - Georgios Dimitrakakis
- Department of Cardiothoracic Surgery, University Hospital of Wales, Cardiff, United Kingdom
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Iatrogenic Aortocoronary Arteriovenous Fistula following Coronary Artery Bypass Surgery: A Case Report and Complete Review of the Literature. Case Rep Cardiol 2012; 2012:652086. [PMID: 24826267 PMCID: PMC4008282 DOI: 10.1155/2012/652086] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 10/18/2012] [Indexed: 11/18/2022] Open
Abstract
The case of a patient who presented with angina following a coronary artery bypass (CABG) operation during which the left internal mammary artery was inadvertently anastomosed to a cardiac vein is presented. The literature concerning previously reported cases of aortocoronary arteriovenous fistulas (ACAVF) due to inadvertent grafting of a coronary vein is reviewed and the significance of this complication is discussed. ACAVF due to inadvertent grafting of a coronary vein is a rare complication of CABG and may be a more common cause of graft failure than has previously been recognized. Distortion of cardiac anatomy, the presence of epicardial fat, and an intramyocardial course of the artery intended for grafting are predisposing factors. Some patients present with angina pectoris and heart failure whereas others have no symptoms. The diagnostic test of choice is coronary angiography. Cardiac MRI and CT have a limited role due to the smaller size and the more clearly defined course of these fistulas. Asymptomatic patients are simply observed since spontaneous closure of these fistulas is reported. Symptomatic patients can be treated with combined medical management and percutaneous methods.
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Blaschke F, Baur A, Roser M, Attanasio P, Ozcelik C, Haverkamp W, Boldt LH. Absent proximal right coronary artery with a fistula into the pulmonary vein. Europace 2012; 14:1369-70. [PMID: 22628451 DOI: 10.1093/europace/eus090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
A 32-year-old woman was admitted with a third-degree atrioventricular block. A permanent pacemaker was implanted and the patient was discharged. One week later, the patient presented again with a sustained ventricular tachycardia. Coronary angiography and computed tomography imaging with three-dimensional reconstructions revealed the absence of the proximal part of the right coronary artery (RCA) with a fistula into the pulmonary vein. This is the first case describing an absent proximal RCA combined with a pulmonary vein fistula.
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Affiliation(s)
- Florian Blaschke
- Charité - Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Medizinische Klinik mit Schwerpunkt Kardiologie, Augustenburger Platz 1, 13353 Berlin, Germany.
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Watanabe M, Kojima Y, Nogaki H, Kunieda T. A coronary artery fistula with a giant aneurysm. Intern Med 2012; 51:2985. [PMID: 23064583 DOI: 10.2169/internalmedicine.51.8628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Mitsuru Watanabe
- Department of Internal Medicine, Matsunami General Hospital, Japan
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Said SA. Current characteristics of congenital coronary artery fistulas in adults: A decade of global experience. World J Cardiol 2011; 3:267-77. [PMID: 21876777 PMCID: PMC3163242 DOI: 10.4330/wjc.v3.i8.267] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 06/16/2011] [Accepted: 06/23/2011] [Indexed: 02/06/2023] Open
Abstract
AIM To describe the characteristics of coronary artery fistulas (CAFs) in adults, including donor vessels and whether termination was cameral or vascular. METHODS A PubMed search was performed for articles between 2000 and 2010 to describe the current characteristics of congenital CAFs in adults. A group of 304 adults was collected. Clinical data, presentations, diagnostic modalities, angiographic fistula findings and treatment strategies were gathered and analyzed. With regard to CAF origin, the subjects were tabulated into unilateral, bilateral or multilateral fistulas and compared. The group was stratified into two major subsets according to the mode of termination; coronary-cameral fistulas (CCFs) and coronary-vascular fistulas (CVFs). A comparison was made between the two subsets. Fistula-related major complications [aneurysm formation, infective endocarditis (IE), myocardial infarction (MI), rupture, pericardial effusion (PE) and tamponade] were described. Coronary artery-ventricular multiple micro-fistulas and acquired CAFs were excluded as well as anomalous origin of the coronary arteries from the pulmonary artery (PA). RESULTS A total of 304 adult subjects (47% male) with congenital CAFs were included. The mean age was 51.4 years (range, 18-86 years), with 20% older than 65 years of age. Dyspnea (31%), chest pain (23%) and angina pectoris (21%) were the prevalent clinical presentations. Continuous cardiac murmur was heard in 82% of the subjects. Of the applied diagnostic modalities, chest X-ray showed an abnormal shadow in 4% of the subjects. The cornerstone in establishing the diagnosis was echocardiography (68%), and conventional contrast coronary angiography (97%). However, multi-slice detector computed tomography was performed in 16%. The unilateral fistula originated from the left in 69% and from the right coronary artery in 31% of the subjects. Most patients (80%) had unilateral fistulas, 18% presented with bilateral fistulas and 2% with multilateral fistulas. Termination into the PA was reported in unilateral (44%), bilateral (73%) and multilateral (75%) fistulas. Fistulas with multiple origins (bilateral and multilateral) terminated more frequently into the PA (29%) than into other sites (10.6%) (P = 0.000). Aneurysmal formation was found in 14% of all subjects. Spontaneous rupture, PE and tamponade were reported in 2% of all subjects. In CCFs, the mean age was 46.2 years whereas in CVFs mean age was 55.6 years (P = 0.003). IE (4%) was exclusively associated with CCFs, while MI (2%) was only found in subjects with CVFs. Surgical ligation was frequently chosen for unilateral (57%), bilateral (51%) and multilateral fistulas (66%), but percutaneous therapeutic embolization (PTE) was increasingly reported (23%, 17% and 17%, respectively). CONCLUSION Congenital CAFs are currently detected in elderly patients. Bilateral fistulas are more frequently reported and PTE is more frequently applied as a therapeutic strategy in adults.
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Affiliation(s)
- Salah Am Said
- Salah AM Said, Department of Cardiology, Hospital Group Twente, Location Hengelo, 7555 DL Hengelo, The Netherlands
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Yildiz A, Okcun B, Peker T, Arslan C, Olcay A, Bulent Vatan M. Prevalence of coronary artery anomalies in 12,457 adult patients who underwent coronary angiography. Clin Cardiol 2011; 33:E60-4. [PMID: 21184546 DOI: 10.1002/clc.20588] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Coronary artery anomalies are found in 0.2% to 1.3% of patients undergoing coronary angiography and 0.3% of an autopsy series. We aimed to estimate the frequency of coronary artery anomalies in our patient population. METHODS The data were collected retrospectively by analyzing the angiographic data of 12 457 consecutive adult patients undergoing coronary angiography between September 2002 and October 2007. RESULTS Coronary artery anomalies were found in 112 patients (0.9% incidence), 100 patients (89.3%) had origin and distribution anomalies, and 12 patients (10.7%) had coronary artery fistulae. Their mean age was 52 ± 8 years (range, 22-79 y). Separate origins of left anterior descending and left circumflex coronary artery from the left sinus of Valsalva was the most common anomaly (63.4%). The right coronary artery rising from the left coronary sinus of Valsalva was found in 10 (8.9%) patients. Anomalous origin of the left circumflex coronary artery from the right sinus of Valsalva was seen in 10 (8.9%) patients. The left main coronary artery from the right coronary sinus of Valsalva was found in 1 (0.89%) patient while an isolated single coronary artery was seen in 2 (1.78%) patients. CONCLUSION The incidence and the pattern of coronary artery anomalies in our patient population were almost identical with previous studies. Cardiologists should be aware of the coronary anomalies which may be associated with potentially serious cardiac events, because recognition of these coronary anomalies is mandatory in order to prescribe appropriate therapy.
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Affiliation(s)
- Ahmet Yildiz
- Department of Cargiology, Gazi Hospital, Izmir, Turkey.
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Oto MA, Yorgun H, Aytemir K. Percutaneous approaches to closure of coronary artery fistulas. Interv Cardiol 2011. [DOI: 10.2217/ica.10.91] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Kim SH, Ko JS, Yoon HJ, Lim SC, Cho SH, Kim HS, Lee JS, Park JC. A Case of Coronary Arteriovenous Fistula Associated with Giant Coronary Artery Aneurysm. J Cardiovasc Ultrasound 2009. [DOI: 10.4250/jcu.2009.17.2.70] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Soo-Hyun Kim
- Department of Cardiology, The Heart Center, Chonnam National University Hospital, Cardiovascular Research Institute, Chonnam National University Medical School, Gwangju, Korea
| | - Jum-Suk Ko
- Department of Cardiology, The Heart Center, Chonnam National University Hospital, Cardiovascular Research Institute, Chonnam National University Medical School, Gwangju, Korea
| | - Hyun-Ju Yoon
- Department of Cardiology, The Heart Center, Chonnam National University Hospital, Cardiovascular Research Institute, Chonnam National University Medical School, Gwangju, Korea
| | - Sang-Chun Lim
- Department of Cardiology, The Heart Center, Chonnam National University Hospital, Cardiovascular Research Institute, Chonnam National University Medical School, Gwangju, Korea
| | - Sook-Hee Cho
- Department of Cardiology, The Heart Center, Chonnam National University Hospital, Cardiovascular Research Institute, Chonnam National University Medical School, Gwangju, Korea
| | - Hey-Sook Kim
- Department of Cardiology, The Heart Center, Chonnam National University Hospital, Cardiovascular Research Institute, Chonnam National University Medical School, Gwangju, Korea
| | - Ji-Sun Lee
- Department of Cardiology, The Heart Center, Chonnam National University Hospital, Cardiovascular Research Institute, Chonnam National University Medical School, Gwangju, Korea
| | - Jong Chun Park
- Department of Cardiology, The Heart Center, Chonnam National University Hospital, Cardiovascular Research Institute, Chonnam National University Medical School, Gwangju, Korea
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Koch A, Sebening C, DeSimone R, Jahn L, Sack FU, Hagl S. Coronary fistula of right coronary artery to vena cava superior and ectasia of pulmonary artery. ACTA ACUST UNITED AC 2006; 94:813-6. [PMID: 16382382 DOI: 10.1007/s00392-005-0291-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2005] [Accepted: 07/01/2005] [Indexed: 10/25/2022]
Abstract
We report on a patient with coronary heart disease, a coronary fistula of right coronary artery to vena cava superior and pulmonary hypertension. Combined with coronary artery revascularization, the coronary fistula was closed successfully.
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Affiliation(s)
- A Koch
- University of Heidelberg, Department of Cardiac Surgery, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
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Olgunturk R, Kula S, Tunaoglu FS. Transcatheter closure of a rare form of coronary arteriovenous fistula (circumflex artery to coronary sinus). Int J Cardiol 2005; 113:261-3. [PMID: 16318882 DOI: 10.1016/j.ijcard.2005.09.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2005] [Revised: 09/04/2005] [Accepted: 09/21/2005] [Indexed: 11/20/2022]
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