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Velázquez‐Castañeda R, De La Puente‐Tawil I, Molina‐Castillo S, Proaño‐Bernal L, Rodríguez‐Salazar MA, Masso‐Bueso S, Alexanderson‐Rosas E, Arenas‐Fabbri V. Coronary-cameral fistula in an infant patient: An incidental diagnosis. Clin Case Rep 2023; 11:e8172. [PMID: 38028060 PMCID: PMC10654555 DOI: 10.1002/ccr3.8172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/03/2023] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
Coronary artery fistula is a rare abnormal connection between the heart arteries. Patients may remain asymptomatic until adulthood, potentially experiencing life-threatening complications. Adequate monitoring and therapeutic management are essential.
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Affiliation(s)
| | | | | | - Leonardo Proaño‐Bernal
- Instituto Nacional de Cardiología Ignacio ChávezMexico CityMexico
- Universidad Nacional Autónoma de MexicoMexico CityMexico
| | | | | | - Erick Alexanderson‐Rosas
- Instituto Nacional de Cardiología Ignacio ChávezMexico CityMexico
- Universidad Nacional Autónoma de MexicoMexico CityMexico
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Boumaaz M, Faraj R, Lakhal Z, Benyass A, Asfalou I. Complex Coronary Artery Fistula in a Young Adult: Not Seeing the Wood for the Trees. Cureus 2023; 15:e49503. [PMID: 38152799 PMCID: PMC10752431 DOI: 10.7759/cureus.49503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2023] [Indexed: 12/29/2023] Open
Abstract
Coronary artery fistulas (CAFs) represent rare congenital anomalies that exhibit a wide range of clinical implications and a heightened risk of complications. It is imperative to accurately identify and delineate these fistulas to avoid missed diagnoses and to recommend suitable therapeutic measures. We present the case of a 46-year-old obese woman who was hospitalized for chest pain associated with palpitations. Clinical examination and ECG results were within normal limits. A 24-hour ECG holter revealed paroxysmal atrial fibrillation. Transthoracic echocardiography revealed a systolodiastolic aliasing originating from the aorta and coursing along the right atrium. Transesophageal echocardiography and coronary angiography confirmed this finding. The diagnosis of a voluminous and tortuous coronary-cameral fistula was established through coronary CT angiography with 3D reconstruction images. A positive stress test indicated the need for surgical closure, given the size and aneurysmal nature of the fistula. However, the patient unfortunately passed away two days after the surgery. This case highlights the critical need for precise identification and management of CAFs. The patient's unfortunate post-surgical outcome underscores the complexity and risks associated with these anomalies, emphasizing the ongoing need for improved treatment strategies and research in this area.
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Affiliation(s)
- Meriem Boumaaz
- Department of Cardiology, Mohammed V Military Hospital, Mohammed V University, Rabat, MAR
| | - Raid Faraj
- Department of Cardiology, Mohammed V Military Hospital, Mohammed V University, Rabat, MAR
| | - Zouhair Lakhal
- Department of Cardiology, Mohammed V Military Hospital, Mohammed V University, Rabat, MAR
| | - Atif Benyass
- Department of Cardiology, Mohammed V Military Hospital, Mohammed V University, Rabat, MAR
| | - Iliyasse Asfalou
- Department of Cardiology, Mohammed V Military Hospital, Mohammed V University, Rabat, MAR
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Cai R, Ma X, Zhao X, Xu J, Zhu L, Ku L. CTA analysis of 482 cases of coronary artery fistula: A large-scale imaging study. J Card Surg 2022; 37:2172-2181. [PMID: 35508600 DOI: 10.1111/jocs.16500] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/13/2022] [Accepted: 03/23/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The prevalence of coronary artery fistula (CAF) based on coronary angiography has been reported. However, with the popularity of coronary computerized tomography angiography (CTA), CAFs have been found more and more by chance. The purpose of this study was to determine the prevalence and types of CAFs detected by coronary CTA, and to explore the differences in the size of fistulas, the number of complicated aneurysms, and fistulas among different types. MATERIALS AND METHODS From January 2016 to December 2020, 96,037 patients underwent coronary CTA in our hospital. The prevalence of CAF was retrospectively evaluated, The origin, course, and drainage site of CAF and coexisting abnormalities were analysed. The conventional treatments and follow-up DSCT images were also evaluated. Analyze the difference between the coronary-pulmonary artery fistula (CPAFs) group (380) and the coronary-cameral fistula (CCF) group (99). RESULTS Among 96,037 patients, 482 (0.5%) patients (male 232 and 250 female) had CAF. The types of CAF detected. The pulmonary artery was the most common site of drainage (380/482, 78.8%). Of the 99 CCFs, coronary to the left ventricle is the most common pattern in CCF (34/482, 7.0%). Single origins are more common in CAF (n = 361, 74.9%), multiple origins are more common in CPAFs than in CCF. There were statistically significant differences in the stoma diameter (2.4 ± 1.1 mm vs. 5.4 ± 4.3 mm p < .05), aneurysm complicated (85 cases [85/380] vs. 50 cases [50/99]), the size of aneurysm (8.8 ± 5.7 mm vs. 19.1 ± 11.6 mm, p < .05), and single fistula (261 [261/380] vs. 96 [96/99], p < .05). Most of the 380 CPAFs patients received conservative treatment (350/380, 92.1%), While the 59 CCF patients (59/93, 63.4%) were treated. CONCLUSIONS Different from previous reports, the prevalence of CAF in coronary CTA is 0.5%, the incidence of CPAFs is the highest, and the incidence of the left ventricular fistula is higher in CCF. Compared with CPAFs, CCF fistulas were more likely to be associated with a larger diameter of draining, larger aneurysms, single fistula pattern. Coronary artery CTA is a useful and noninvasive imaging method to detect CAF, which is of great significance for the detection of small fistulas and the surgical guidance of complex CAF.
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Affiliation(s)
- Renhui Cai
- Wuhan University of Science and Technology, Wuhan Asian Heart Hospital Imaging Centre, Wuhan, Hubei, China
| | - Xiaojing Ma
- Wuhan University of Science and Technology, Wuhan Asian Heart Hospital Imaging Centre, Wuhan, Hubei, China
| | - Xinxiang Zhao
- Department of Radiology, The Second Affifiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Juan Xu
- Wuhan University of Science and Technology, Wuhan Asian Heart Hospital Imaging Centre, Wuhan, Hubei, China
| | - Li Zhu
- Wuhan University of Science and Technology, Wuhan Asian Heart Hospital Imaging Centre, Wuhan, Hubei, China
| | - Leizhi Ku
- Wuhan University of Science and Technology, Wuhan Asian Heart Hospital Imaging Centre, Wuhan, Hubei, China
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An extremely rare coronary artery fistula extending from the sinoatrial nodal artery to the right atrium. TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2022; 30:299-301. [PMID: 36168578 PMCID: PMC9473607 DOI: 10.5606/tgkdc.dergisi.2022.22625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 11/07/2021] [Indexed: 11/21/2022]
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Rodriguez MJ, Gallo-Bernal S, Calixto CA, Medina L, Pardo EJ, Ocampo González M. Multiple Coronary Fistulas After Several Penetrating Chest Wounds: A Rare Case of Refractory Heart Failure. JACC Case Rep 2021; 3:34-38. [PMID: 34317464 PMCID: PMC8305110 DOI: 10.1016/j.jaccas.2020.08.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/18/2020] [Accepted: 08/21/2020] [Indexed: 11/29/2022]
Abstract
Coronary artery fistulas are rare coronary abnormalities. Most of these fistulas have a congenital origin, and only a few are acquired. We report the case of a patient with late-acquired multiple coronary fistulas secondary to a stab wound, diagnosed in the setting of ischemic heart failure secondary to coronary steal syndrome. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Maria J Rodriguez
- Division of Heart Failure, Fundación Cardioinfantil, Institute of Cardiology, Bogota, Colombia
| | - Sebastian Gallo-Bernal
- Division of Heart Failure, Fundación Cardioinfantil, Institute of Cardiology, Bogota, Colombia
| | - Camilo A Calixto
- Division of Heart Failure, Fundación Cardioinfantil, Institute of Cardiology, Bogota, Colombia
| | - Libardo Medina
- Universidad de Santander, Bucaramanga, Colombia.,Fundación Cardiovascular de Colombia, Bucaramanga, Colombia
| | | | - Mónica Ocampo González
- Universidad de Santander, Bucaramanga, Colombia.,Fundación Cardiovascular de Colombia, Bucaramanga, Colombia
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Siripornpitak S, Sriprachyakul A, Promphan W, Mokarapong P, Wanitkun S. Coronary artery changes in congenital coronary-cameral fistulas evaluated by computed tomographic angiography. Jpn J Radiol 2021; 39:1149-1158. [PMID: 34181176 DOI: 10.1007/s11604-021-01164-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/21/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE The study sought to determine coronary artery diameter in congenital coronary-cameral fistula (cCCF), factors associated with coronary artery aneurysm, coronary artery changes after fistula closure, and computed tomographic (CT) findings after treatment. MATERIALS AND METHODS We retrospectively reviewed CT findings of the cCCF for origins, terminations, fistula length, complexities, and Sakakibara classification. Coronary artery diameter was expressed as coronary artery Z score. Fistula features associated with coronary artery aneurysm were analyzed. Post-fistula closures were analyzed for coronary artery dilatation, coronary thrombosis, complete fistula closure, and fistula thrombosis. RESULTS Twenty-five patients (median age 33 months, interquartile range, IQR 25-48) were included. Coronary feeders and terminations were frequently right coronary artery (48%) and right ventricle (56%), respectively. Fistula aneurysm occurred in 52% of cases. Mean coronary artery Z score was 13.03 ± 6.36 with a high incidence of giant coronary artery aneurysm (68%). We found no statistically significant risk factors associated with coronary artery aneurysm (p value range 0.075-0.370). Median duration of the follow-up CT after closure of the fistulas was 6.4 months (IQR 5.0-8.7). Coronary artery Z score significantly decreased by 0.82 (IQR 0.28-1.35), p = 0.006 and coronary thrombosis occurred in 23% of cases during follow-up. CONCLUSIONS Large coronary aneurysm is common in cCCF. No characteristic feature of the fistula influencing coronary artery aneurysm is identified. There is a diminution in coronary artery Z score after fistula closure. Coronary thrombosis is a major complication after treatment.
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Affiliation(s)
- Suvipaporn Siripornpitak
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Phayatai, Ratchathewi, Bangkok, 10400, Thailand. .,Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, 270 Rama 6 Road, Phayatai, Ratchathewi, Bangkok, 10400, Thailand.
| | - Apichaya Sriprachyakul
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Phayatai, Ratchathewi, Bangkok, 10400, Thailand.,Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, 270 Rama 6 Road, Phayatai, Ratchathewi, Bangkok, 10400, Thailand
| | - Worakan Promphan
- Department of Pediatrics, Queen Sirikit National Institute of Child Health, Rangsit University, 420/8 Phayatai Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Pirapat Mokarapong
- Cardiovascular and Thoracic Surgery Unit, Department of Surgery, Institute of Cardiovascular Diseases, Rajavithi Hospital, 2 Phayatai Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Suthep Wanitkun
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Phayatai, Ratchathewi, Bangkok, 10400, Thailand.,Division of Cardiology, Department of Pediatrics, Mahidol University, 270 Rama 6 Road, Phayatai, Ratchathewi, Bangkok, 10400, Thailand
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Qian W, Liu W, Zhu Y, Wang J, Chen Y, Meng H, Chen L, Xu Y, Zhu X. Influence of heart rate and coronary artery calcification on image quality and diagnostic performance of coronary CT angiography: comparison between 96-row detector dual source CT and 256-row multidetector CT. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2021; 29:529-539. [PMID: 33749627 DOI: 10.3233/xst-210837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND CT-derived fractional flow reserve (FFRCT) and diagnostic accuracy rely on good image quality during coronary CT angiography (CCTA). OBJECTIVE To investigate whether heart rate (HR) and coronary artery calcium (CAC) score decrease image quality and diagnostic performance of two advanced CT scanners including 96-row detector dual source CT (DSCT) and 256-row multidetector CT (MDCT). METHODS First, 79 patients who underwent CCTA (42 with DSCT and 37 with MDCT) and invasive coronary angiography (ICA) are enrolled. Next, coronary segments with excellent image quality are evaluated and the percentage is calculated. Then, diagnostic accuracy in detecting significant diameter stenosis is presented with ICA as the reference standard. RESULTS Compared with the DSCT, the percentage of coronary segments with excellent image quality is lower (P = 0.010) while diagnostic accuracy on per-segment level is improved (P = 0.037) using MDCT. CAC score≥400 is the only independent factor influencing the percentage of coronary segments with excellent image quality [odds ratio (OR): DSCT, 3.096 and MDCT, 1.982] and segmental diagnostic accuracy (OR: DSCT, 2.630 and MDCT, 2.336) for both scanners. HR≥70 bpm (OR: 5.506) is the independent factor influencing the percentage of coronary segments with excellent image quality with MDCT. CONCLULSION During CCTA, CAC score≥400 still decreases the proportion of coronary segments with excellent image quality and diagnostic accuracy with advanced CT scanners. HR≥70 bpm is another factor causing image quality decreasing with MDCT.
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Affiliation(s)
- Wen Qian
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wangyan Liu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yinsu Zhu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jun Wang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yang Chen
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Haoyu Meng
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Leilei Chen
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yi Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaomei Zhu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Liu H, Li X, Song H, Wei W. Anesthesia Management for a Patient with Coronary Artery Fistula and Huge Coronary Aneurysm Undergoing Off-Pump Surgery. J Cardiothorac Vasc Anesth 2020; 34:1885-1889. [PMID: 32178951 DOI: 10.1053/j.jvca.2020.02.002] [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: 09/03/2019] [Revised: 01/30/2020] [Accepted: 02/02/2020] [Indexed: 02/08/2023]
Affiliation(s)
- Haibei Liu
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xiang Li
- Department of Cardiac Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Haibo Song
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Wei Wei
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
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Affiliation(s)
| | - Gary Randall Green
- Department of Cardiothoracic Surgery SUNY Upstate Medical University Syracuse New York
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