Multiple coronary to pulmonary artery fistulas: a case report and review of the literature

Left main coronary artery aneurysm with fistula to superior vena cava: A challenging case

Coronary artery fistulas (CAFs) are rare congenital coronary artery abnormalities, with direct communication between a coronary artery and a cardiac chamber, great vessel or other structure. We report here, a rare case of a 25-year-old male with CAF from the aneurysmal left main coronary artery to the superior vena cava detected on echocardiography and computerized tomography (CT) coronary angiography.

Left circumflex artery fistula to left atrium: a rare case report

Coronary artery fistulas are rare congenital anomalies of coronary termination. There are 3 types: (1) cameral coronary fistulas, (2) pulmonary coronary fistulas, and (3) bronchial coronary fistulas. Left circumflex coronary artery to left atrial fistula are exceptional. Imaging, especially the CT angiogram, must establish an anatomical classification of the fistula for therapeutic purposes, by specifying its origin, its path, its size and its termination.

We report a rare case of the left circumflex coronary artery to left atrial fistula in a 31 year old man, which is an uncommon presentation of coronary termination anomalies. The CT coronary angiogram must describe the origin segment of the fistula and the drainage site which have therapeutic consequences.

Congenital coronary artery fistulas complicated with pulmonary hypertension: Analysis of 211 cases

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.

Left main coronary artery fistula to superior vena cava

Coronary artery fistula (CAF) is an uncommon vascular malformation. As the majority of patients remain asymptomatic, approximately half of the cases may be clinical undetectable. We report here a rare case of a 10-year-old female with CAF from the left main coronary artery to the superior vena cava detected on echocardiography and CT angiography.

Percutaneous Management of Coronary Artery-to-pulmonary Artery Fistula Using an Amplatzer Vascular Plug with the Trans-radial Approach

Congenital coronary artery fistulas (CAFs) are rare and asymptomatic, although symptomatic CAFs should be treated with percutaneous intervention or surgery. A 62-year-old woman developed bilateral coronary-to-pulmonary artery fistulas resulting in exertional chest pain. We herein report the successful use of trans-catheter closure of a coronary artery-to-pulmonary artery fistula, which lead to the coronary steal phenomenon, using an Amplatzer vascular plug with the trans-radial approach. After the procedure, the patient remained asymptomatic.

Unilateral and multilateral congenital coronary-pulmonary fistulas in adults: clinical presentation, diagnostic modalities, and management with a brief review of the literature

BACKGROUND

Congenital coronary-pulmonary fistulas (CPFs) are commonly unilateral, but bilateral and multilateral fistulas may occur. In multilateral CPFs, the value of a multidetector computed tomography (MDCT) imaging technique as an adjuvant to coronary angiography (CAG) is eminent. The purpose of this study was to describe the clinical presentation, diagnostic modalities, and management of coincidentally detected congenital CPFs.

HYPOTHESIS

Unilateral and multilateral coronary-pulmonary fistulas are increasingly detected due to the wide speard application of multidetector computed tomography which might be a supplementary or replacing to conventional coronary angiography.

METHODS

We evaluated 14 adult patients with congenital coronary artery fistulas (CAFs) who were identified from several Dutch cardiology departments.

RESULTS

Fourteen adult patients (5 female and 9 male), with a mean age of 57.5 years (range, 24-80 years) had the following abnormal findings: audible systolic cardiac murmur (n = 4), chronic atrial fibrillation (n = 2), nonsustained ventricular tachycardia (n = 1), and cardiomegaly on chest x-ray (n = 2). Echocardiography revealed normal findings with trivial valvular abnormalities (n = 9), depressed left ventricle systolic function (n = 3), and severe mitral regurgitation and atrial dilatation (n = 2). The findings in the rest of the patients were unremarkable. CAG and MDCT were used as a diagnostic imaging techniques either alone (CAG, n = 6; MDCT, n = 1) or in combination (n = 7). Single modality and multimodality diagnostic methods revealed 22 fistulas including CPFs (n = 15), coronary cameral fistulas terminating into the right (n = 2) and the left atrium (n = 1), and systemic-pulmonary fistulas (n = 4). Of all of the fistulas, 10 were unilateral, 6 were bilateral, and 6 was hexalateral. (13) N-ammonia positron emission tomography-computed tomography was performed in 3 patients revealing decreased myocardial perfusion reserve.

CONCLUSIONS

CAG remains the gold standard for detection of CPFs. An adjuvant technique using MDCT provides full anatomical details of the fistulas.

A giant coronary artery aneurysm with a fistula followed-up for 12 years using the contrast-enhanced computed tomography scan

We report a case of a 35-year-old woman who was diagnosed with a giant coronary artery aneurysm (CAA) with a fistula and followed-up using the contrast-enhanced computed tomography scan and 2-dimensional transthoracic echocardiography. The diameter and volume cubic content of the giant CAA had increased linearly during the 12-year follow-up period without any complications. As there are few reports about long-term follow-up of giant CAAs without a surgical intervention, the natural course of a giant CAA is still unclear. Thus, we may need to closely follow-up chronological changes of a giant CAA to decide the treatment strategy.

Spontaneous partial regression of coronary artery fistula following optimal medical therapy in a patient who had combined significant coronary artery spasm

Coronary artery fistulas (CAFs) are one of the most rare cardiac anomalies. Some patients with CAF may suffer from ischemic chest pain that originates from combined significant coronary artery spasm (CAS). Spontaneous regression of CAF has been reported in a few cases, almost all of which were infants. We report an adult patient who presented with ischemic chest pain due to multiple coronary arteries to pulmonary artery fistulas and combined significant CAS induced by intracoronary acetylcholine provocation test. Spontaneous regression of one of the fistulas was observed at 2-year angiography follow-up.