The clinical characteristics of coronary artery fistula anomalies in children and adults: A 24‐year experience

Imaging characteristics and ECG distribution of coronary fistulas: The first large-scale study

BACKGROUND

The proportion of abnormal electrocardiogra (ECG) in patients with coronary artery fistula (CAF) is relatively high, but the correlation between CAF and arrhythmia is mostly reported in individual case studies. This paper analyzes the correlation between imaging features and ECG features.

OBJECTIVE

This paper aims to analyze the incidence and distribution characteristics of abnormal ECG in patients with CAF and further explore the difference in ECG characteristics between coronary-cameral fistula (CCF) and coronary-pulmonary artery fistula (CPAF).

METHOD

A total of 144,448 patients who underwent coronary computerized tomography angiography (CTA) examination from January 2016 to December 2022 were included in this study, and 284 patients with CAF (excluding coronary atherosclerosis) were selected for analysis of their ECG and image characteristics. And divided them into the CPAF (221 cases) and CCF (63 cases) groups, the differences in ECG between the two groups was compared. The changes in the ECG after the operation were analyzed.

RESULTS

The incidence of abnormal ECG in patients with CAF was approximately 72.9%. There were significant differences in the proportion of ECG block, myocardial ischemia and structural ECG changes between the CPAF group and CCF group (P < 0.05). CCF was more likely to cause conduction block and ischemic and structural ECG changes. A total of 53 patients with CAF underwent surgical treatment, 28 patients with improved ECG (52%).

CONCLUSION

CCF especially CCF patients often have abnormal ECG findings such as conduction block, myocardial ischemia, and structural changes, which can often be restored to normal through surgery.

Case report: Surgical management of a rare right coronary artery fistula with a giant pseudoaneurysm compressing the pulmonary vein in a young patient

Congenital coronary artery fistula (CAF) represents a remarkable rarity within the realm of cardiovascular anomalies, characterized by an aberrant connection between coronary arteries and either cardiac chambers or major vessels. Clinical manifestations of CAFs often remain unspecified or may even be entirely absent, posing diagnostic challenges. Notably, patients harboring substantial CAFs may exhibit symptoms such as palpitations, chest tightness, and dyspnea. Although right-sided congenital CAFs are relatively prevalent, the occurrence of a CAF accompanied by a colossal pseudoaneurysm imposing compression upon the pulmonary vein is an exceedingly rare phenomenon. This exceptional case report delineates a singular fistula originating from the right coronary artery, extending its course to the right atrium, and remarkably featuring a substantial pseudoaneurysm exerting compression upon the right superior pulmonary vein. Therapeutic intervention encompassed surgical closure of the proximal artery and excision of the pseudoaneurysm, underscoring the complexity and criticality of managing such intricate cardiac anomalies to ensure optimal patient outcomes.

Surgical repair for left coronary artery-right atrium fistula with giant coronary aneurysm

Background

Coronary artery fistula is a rare coronary anomaly which is defined as a communication between coronary artery and other heart chambers or vascular structures. The coronary artery which supply the fistula with blood can dilated, as a consequence, coronary aneurysm developed.

Case introduction

Coronary artery fistula is frequently asymptomatic in its early stage, here we report a 26-year-old woman with left coronary artery fistula and left coronary artery aneurysm who presented in our hospital with dyspnea, fatigue and palpitation. The orifice of fistula was closed by continuous suture via right atriotomy. The wall of the aneurysm and enlarged LCA were partially resected along its longitudinal axis so that we can reduce the diameter of LCA to approximately normal.

Conclusion

This technique provides a safe method for surgical repair of the giant coronary artery aneurysm with CAF.

Coronary artery-left ventricular multiple microfistulas, a rare disease that is easily missed: case report and literature review

Coronary artery-left ventricular multiple microfistulas (CALVMMFs) are a very rare type of coronary artery fistula. Because of their special anatomical structure and hemodynamics, CALVMMFs often result in no obvious symptoms and signs. Most patients are diagnosed by coronary angiography; however, as a routine noninvasive screening method, Doppler echocardiography is a potential first-choice diagnostic technique for patients with CALVMMFs. Although satisfactory results of CALVMMF closure are difficult to achieve, the clinical symptoms of these patients are not obvious, and drug therapy has a clear therapeutic effect on most patients. We herein introduce seven cases of CALVMMFs confirmed by our hospital and briefly review the related literature.

Right coronary artery-coronary sinus fistula diagnosed by three-dimensional echocardiography

Right coronary artery-coronary sinus fistula is a very rare congenital anomaly in which a right coronary artery fistula drains into the right atrium, right ventricle, or pulmonary artery. A right coronary artery-coronary sinus fistula was diagnosed in a 44-year-old man by three-dimensional echocardiography and confirmed by computed tomography angiography and surgery. Relevant published experience in diagnosing this kind of anomaly is summarized.

Surgical treatment of heart failure due to giant coronary artery fistula: a case report

Coronary artery fistula is a rare congenital cardiac anomaly that is often found incidentally during computed tomography angiography. Coronary fistula between the left circumflex coronary artery and the coronary sinus is among the less common forms of coronary artery fistula. A 60‐yea\r‐old female patient presented to our outpatient cardiology department with symptoms of severe, de novo heart failure. Echocardiogram revealed severe mitral regurgitation and a dilated duct that turbulently accelerated colour Doppler flow behind the left ventricle with significant left‐to‐right shunt. Cardiac magnetic resonance imaging and computed tomography angiography revealed a massively dilated fistula between the left circumflex coronary artery and the coronary sinus with a diameter of 3–4 cm. The patient underwent combined heart surgery involving mitral ring annuloplasty and fistula ligation and was discharged in stable condition on guideline‐based medical therapy. At 18 months of follow‐up, minimal residual shunt flow and mild‐to‐moderate mitral regurgitation were found. We report a rare case of congenital coronary disorder resulting in heart failure and highlight the importance of complex non‐invasive cardiac diagnostic procedures before planning and performing heart surgery.

An unusual case of prenatal diagnosis of right coronary artery to right ventricle fistula with HD-flow render mode and spatiotemporal image correlation (STIC)

Coronary artery fistula is rare in prenatal diagnosis. We have reported a case diagnosis of coronary artery fistula by using high-definition flow (HD-flow) render mode and spatiotemporal image correlation (STIC), and then evaluated the postnatal outcomes in our hospital.