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Diab KA, Boujemline Y, Hijazi ZM. Update on shunt closure in neonates and infants. Expert Rev Cardiovasc Ther 2021; 19:475-492. [PMID: 33899641 DOI: 10.1080/14779072.2021.1922079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Cardiac defects that result in shunting are the most common types of congenital heart anomalies. Although these lesions can be simple, they can cause significant hemodynamic changes and can be challenging to manage in neonates and infants. Over the recent decades, the development of new transcatheter techniques and devices has made it safe and feasible to manage such defects when indicated, even in the smallest of patients. Understanding these interventional procedures is essential in order to manage those patients.Areas covered: In this article, we review the techniques and experience for closure of atrial septal defects, ventricular septal defects, patent ductus aarteriosus,as well as coronary arteriovenous malformations and fistulas in neonates and infants. Literature review of PubMed articles was performed through January 2021, with focus on the latest data and results of the usage of interventional techniques in treating these lesions specifically in this age-group.Expert opinion: Significant shunting lesions can be particularly challenging to manage in neonates and infants. Newer lower profile devices will likely continue to be developed in the future, allowing their use for transcatheter interventions in even smaller patients and those with more complex anatomy.
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Affiliation(s)
- Karim A Diab
- Department of Pediatrics, Sidra Heart Center, Sidra Medicine, Doha, Qatar
| | - Younes Boujemline
- Department of Pediatrics, Sidra Heart Center, Sidra Medicine, Doha, Qatar
| | - Ziyad M Hijazi
- Department of Pediatrics, Sidra Heart Center, Sidra Medicine, Doha, Qatar.,Weill Cornell Medical College, Doha, Qatar.,Weill Cornell Medical College, New York, NY, USA
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2
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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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3
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Baggio TC, Sebold L, Oliveira ICD. Case Report: Surgical Treatment of High-Flow Coronary Fistulas for the Pulmonary Artery. Braz J Cardiovasc Surg 2020; 35:392-395. [PMID: 31165615 PMCID: PMC7299589 DOI: 10.21470/1678-9741-2018-0327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Coronary fistulas are rare anomalies that can affect approximately 1% of the population, presenting few specific symptoms, and are often found occasionally in coronary angiography. Here we describe the case of a 61-year-old patient with complaints of precordialgia and dyspnea since adolescence, with late diagnosis of coronary fistulas with drainage to the pulmonary artery, and with unsuccessful percutaneous treatment. Therefore, she underwent open surgery for the correction of the already known fistulas, in addition to the hemangioma involving such vessels, which made the understanding and resolution of this case more complex.
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Affiliation(s)
- Thales Cantelle Baggio
- Hospital e Maternidade Jaraguá Jaraguá do Sul SC Brazil Hospital e Maternidade Jaraguá, Jaraguá do Sul, SC, Brazil
| | - Larissa Sebold
- Universidade Regional de Blumenau Ringgold Standard Institution Blumenau SC Brazil Universidade Regional de Blumenau, Ringgold Standard Institution, Blumenau, SC, Brazil
| | - Igor Cordeiro de Oliveira
- Universidade Regional de Blumenau Ringgold Standard Institution Blumenau SC Brazil Universidade Regional de Blumenau, Ringgold Standard Institution, Blumenau, SC, Brazil
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4
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Jaswal V, Thingnam SKS, Kumar V, Uppal L, Toshkhani D. Congenital right coronary artery aneurysm with fistula to right ventricle associated with isolated pulmonary valvular stenosis. J Card Surg 2020; 35:1152-1155. [PMID: 32302027 DOI: 10.1111/jocs.14552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 04/05/2020] [Indexed: 11/29/2022]
Abstract
Congenital aneurysmal dilatation of coronary artery with coronary cameral fistula is rare in childhood. We report an even rarer association of congenital right coronary artery aneurysm and right coronary artery to right ventricle fistula with bicuspid pulmonary valve stenosis and an intact ventricular septum in a 3-year-old child.
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Affiliation(s)
- Vivek Jaswal
- Department of Cardiovascular and Thoracic Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shyam K S Thingnam
- Department of Cardiovascular and Thoracic Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Kumar
- Department of Cardiovascular and Thoracic Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Lipi Uppal
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Dheemta Toshkhani
- Department of Anaesthesia and Critical Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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5
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Kumar B, Kumar A, Kumar G, Singh H. Role of transesophageal echocardiography in surgical retrieval of embolized amplatzer device and closure of coronary-cameral fistula. Ann Card Anaesth 2017; 20:351-354. [PMID: 28701605 PMCID: PMC5535581 DOI: 10.4103/aca.aca_196_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Congenital coronary artery fistula is an uncommon anomaly. Transcatheter coil embolization or Amplatzer vascular plug device closure of fistula is often done in symptomatic patients with safe accessibility to the feeding coronary artery. Embolization of Amplatzer vascular plug device is rare. We report an 11-year-old male child who presented to us with increasing shortness of breath for 7 years. He had a history of Amplatzer vascular plug device closure of right coronary–cameral fistula 8 years back. Echocardiography demonstrated a dilated aneurysmal right coronary artery with turbulent jet entering into the right ventricle (RV) and device embolized into the left pulmonary artery (LPA). Cardiac catheterization eventually confirmed the diagnosis. Surgical closure of fistula and retrieval of device was done using cardiopulmonary bypass. Intraoperatively transesophageal echocardiogram helped in localizing fistula opening in the RV below the anterior leaflet of tricuspid valve, continuous monitoring to prevent further distal embolization of the device during surgical handling, and assessment of completeness of repair of the fistula and LPA following retrieval of the device.
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Affiliation(s)
- Bhupesh Kumar
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Alok Kumar
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ganesh Kumar
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harkant Singh
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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6
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Liu Y, Liu Y, Xiong M, Li H, Liu D, Zhang X. Large left circumflex coronary artery with a fistula to superior vena cava: Diagnosis by echocardiography. Echocardiography 2017; 34:617-620. [PMID: 28247457 DOI: 10.1111/echo.13481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The left circumflex coronary artery associated with a fistula to superior vena cava is a rare entity. We describe a 7-year-old girl who presented with a cardiac murmur and was diagnosed with a coronary artery fistula between the left circumflex artery and superior vena cava by echocardiography. The surgical occlusion of the fistula was successful.
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Affiliation(s)
- Yunqi Liu
- Department of Cardiac Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
| | - Yanqiu Liu
- Department of Ultrasound, First Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
| | - Mai Xiong
- Department of Cardiac Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
| | - Hanzhao Li
- Department of Cardiac Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
| | - Donghong Liu
- Department of Ultrasound, First Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
| | - Xi Zhang
- Department of Cardiac Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou City, China
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7
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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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Pediatric coronary artery fistula: echocardiographic case reports and literature review of treatment strategy. SPRINGERPLUS 2016; 5:1583. [PMID: 27652156 PMCID: PMC5025422 DOI: 10.1186/s40064-016-3276-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 09/08/2016] [Indexed: 11/21/2022]
Abstract
Background Coronary artery fistula (CAF) is a rare cardiac anomaly. Application of transthoracic echocardiography (TTE) is not fully illustrated in pediatric period. Meanwhile, the treatment strategy of CAF is still a controversial issue. Case presentation Five cases of CAF with different types were presented. We also retrospectively reviewed 32 records of CAF in our institution from May 2001 to January 2015, including cardiac murmurs, symptoms, TTE diagnoses, complications, other anomalies, treatment and outcome. We summarized the most acceptable treatment strategy for pediatric patients. 71.9 % of all (23/32) had murmurs, 15.6 % of all (5/32) had symptoms. 24 patients received surgery or other imaging examination after TTE. 87.5 % of all (21/24) were correctly and accurately diagnosed by echocardiography, including pointing out the origin and outlet of CAF and complication. During the followup of all 32 patients, there was no spontaneous closure, heart failure, infective endocarditis or death case. Conclusions TTE is a useful method that should be considered in the investigation and follow up of pediatric coronary artery fistula. The treatment strategy for pediatric patients should be individuation.
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9
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Said SAM. Characteristics of Congenital Coronary Artery Fistulas Complicated with Infective Endocarditis: Analysis of 25 Reported Cases. CONGENIT HEART DIS 2016; 11:756-765. [DOI: 10.1111/chd.12392] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2016] [Indexed: 02/06/2023]
Affiliation(s)
- Salah AM Said
- Department of Cardiology; Hospital Group Twente; Hengelo The Netherlands
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10
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Lo MH, Lin IC, Hsieh KS, Huang CF, Chien SJ, Kuo HC, Liang CD, Lin YJ. Mid- to long-term follow-up of pediatric patients with coronary artery fistula. J Formos Med Assoc 2015; 115:571-6. [PMID: 26138373 DOI: 10.1016/j.jfma.2015.05.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 05/19/2015] [Accepted: 05/20/2015] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND/PURPOSE To investigate mid- to long-term outcomes in children with coronary artery fistula (CAF). METHODS We retrospectively reviewed the medical records of patients seen between September 1996 and August 2011. We enrolled those diagnosed with CAF via echocardiography (Philips SONOS 7500 system and Philips IE33) or angiography. The mean follow time was 42.58 ± 3.4 months (range, 1-166 months). For comparative purposes, participants were grouped as acquired versus congenital, and symptomatic versus asymptomatic. We also measured the size of the coronary artery (CA) in patients with CA dilatation (CAD). RESULTS Out of 122 CAF patients, spontaneous closure was detected in 37 patients at 21.59 ± 3.45 months after diagnosis. This timeframe did not differ between the acquired and congenital groups (21.64 ± 6.26 months vs. 21.57 ± 4.15 months; p = 0.991). Ninety patients were asymptomatic and remained so; their spontaneous closure rate was 28.89%. Moreover, 24 patients had CAD, including 17 with Kawasaki disease and seven with congenital CAF. The CAs of all congenital-CAF-plus-CAD patients were initially > 5 mm; these patients underwent percutaneous transcatheter intervention, and their CA sizes decreased significantly (6.11 ± 0.79 mm vs. 3.76 ± 0.36 mm; p = 0.002). CONCLUSION With the advanced sensitivity of echocardiography, CAF can be detected more easily than ever before. Most patients with small CAFs are asymptomatic and may experience spontaneous closure. Therefore, management of CAF depends on symptoms; if patients are asymptomatic and have small CAFs, intervention may not be necessary, especially in acquired cases. However, if patients present with symptoms or persistent dilatation of the proximal CA, surgical or percutaneous closure should be performed.
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Affiliation(s)
- Mao-Hung Lo
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - I-Chun Lin
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kai-Sheng Hsieh
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chien-Fu Huang
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shao-Ju Chien
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsuan-Chang Kuo
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chi-Di Liang
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ying-Jui Lin
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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11
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Emre E, Aktas M, Sahin T, Ural E, Ural D. Rare multiple fistulas with large saccular aneurysms originating from left anterior descending artery and left main coronary artery. World J Clin Cases 2014; 2:927-929. [PMID: 25516873 PMCID: PMC4266846 DOI: 10.12998/wjcc.v2.i12.927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 09/02/2014] [Accepted: 10/10/2014] [Indexed: 02/05/2023] Open
Abstract
A 49-year-old female patient consulted us for a cardiac evaluation before undergoing colon adenocarcinoma surgery. Three years prior, the patient underwent coronary angiography for dyspnea. The coronary angiography examination revealed a fistula originating from the left anterior descending artery and left main coronary artery, which had soft aneurysmal sacs and most likely drained into the pulmonary artery. Parasternal short axis echocardiography revealed a color flow that could be related to the fistula, but the other echocardiographic findings were normal. The patient did not accept the proposed examination and invasive treatment.
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12
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Bradley EA, Bachuwar A, Ludbrook PA. A unique case of two sources of right ventricle enlargement in tetralogy of Fallot. World J Pediatr Congenit Heart Surg 2013; 4:103-6. [PMID: 23799763 DOI: 10.1177/2150135112458694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The most common long-term sequelae of tetralogy of Fallot (TOF) are related to acquired late postsurgical pulmonary valve pathology. This is often in the form of pulmonic insufficiency (PI) ultimately leading to right ventricular (RV) enlargement and failure, which may necessitate pulmonary valve replacement. We present a case of severe PI in TOF with an incidental large circumflex to RV fistula and single-vessel coronary artery stenosis in a patient with an enlarged RV. The diagnostic dilemma was to determine whether the RV enlargement was caused by severe PI, shunting from the coronary fistula, or a combination of both.
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Affiliation(s)
- Elisa A Bradley
- Division of Cardiovascular Medicine, School of Medicine, Washington University, St Louis, MO 63110, USA.
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13
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First diagonal coronary artery: left ventricular fistula presenting as unstable angina. Case Rep Cardiol 2013; 2013:908162. [PMID: 24826299 PMCID: PMC4008094 DOI: 10.1155/2013/908162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 07/07/2013] [Indexed: 11/18/2022] Open
Abstract
Coronary artery fistulae are characterized by communications between a coronary artery and a cardiac chamber or another vascular structure. They are usually congenital, but acquired forms may occur. Most patients are usually asymptomatic. However, some studies have emphasized that the incidence of symptoms and complications increases with age, particularly after the age of 20 (Liberthson et al. 1979, Hong et al. 2004). We aimed to present a very rare form of fistula originating from the first diagonal artery and connecting into the left ventricle.
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14
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Tantiongco JP. An uncommon anatomy presenting with a common disease. BMJ Case Rep 2012; 2012:bcr-2012-006189. [PMID: 22962390 DOI: 10.1136/bcr-2012-006189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Coronary artery fistulas are rare anomalous communications, between coronary arteries and cardiac chambers and great vessels. They are often congenital, but usually present in adulthood. They can affect cardiac haemodynamic stability and are thought to predispose patients to heart failure, myocardial ischaemia, myocardial infarction, infective endocarditis, arrythmias and rupture. Herein, a case is discussed where a patient with long-standing stable angina was found to have a coronary artery fistula to the main pulmonary artery and concomitant ischaemic heart disease with a chronically occluded left anterior descending artery, proximal to the fistula. It is thought that the fistula probably predisposed the patient's ischaemic heart disease. He underwent a successful coronary artery bypass grafting plus surgical ligation of the coronary artery fistula. This uncommon coronary artery anomaly, presenting with ischaemic heart disease, a common disease in adulthood, is discussed in the context of current recommedations.
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Affiliation(s)
- John-Paul Tantiongco
- Department of Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia.
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15
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Soares RR, Drumond LF, Araújo LA, Drumond MF, Lorentz MN. Anesthesia for surgical correction of coronary artery fistula without extracorporeal circulation: case report. Rev Bras Anestesiol 2011; 61:770-6. [PMID: 22063378 DOI: 10.1016/s0034-7094(11)70086-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Accepted: 03/14/2011] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Described by Krause in 1865 (1), coronary artery fistula communicating with cardiac cavities, pulmonary artery, or coronary sinus is very rare. It represents 0.2% to 0.4% of congenital cardiopathies and 0.1% and 0.2% of the adult population undergoing coronary angiography (2). The objective of this report is to present the anesthetic management for surgical closure of a coronary fistula in an elective procedure, considering its particularities. CASE REPORT This is a 59-year old male patient, whose coronary fistula was diagnosed during clinical investigation of progressive thoracic pain and long-standing dyspnea. The patient underwent surgical correction of coronary artery fistula under general anesthesia without extracorporeal circulation (ECC). The patient evolved without intercurrences, being discharged from the hospital with clinical improvement 7 days after surgery. CONCLUSIONS Coronary artery fistula is rare, but the anesthesiologist may be faced with this type of patient in distinct situations. Understanding its pathophysiology is important for better perioperative management of the patient, therefore improving the prognosis.
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Affiliation(s)
- Raquel Reis Soares
- Brazilian Society for Pain Study, Acupuncture Specialist, Brazilian Medical Society for Acupuncture, Brazil.
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16
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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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17
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Mitropoulos FA, Kanakis MA, Davlouros PA, Triantis G. Congenital Left Main Coronary Artery to Coronary Sinus Fistula. Heart Surg Forum 2011; 14:E255-7. [DOI: 10.1532/hsf98.20101085] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Congenital coronary artery fistula is an extremely rare anomaly that may involve any of the coronary arteries and any of the cardiac chambers. We report the case of a 14-year-old female patient with a symptomatic congenital coronary fistula starting from the left main coronary artery and draining to the coronary sinus. The patient underwent surgical ligation of the fistula and had an excellent outcome.
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18
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Daniel M, Mavroudis C, Preminger T, Lorber RO, Jacobs ML. Prenatal Diagnosis and Neonatal Surgical Management of a Giant Proximal Right Coronary Artery to Right Ventricular Fistula. World J Pediatr Congenit Heart Surg 2010; 1:243-8. [DOI: 10.1177/2150135110372778] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
We report a case of prenatal diagnosis and early neonatal surgical repair of a large proximal right coronary artery to right ventricular fistula. The surgical findings and technical details of the reparative operation are discussed in the context of the differential diagnosis, which, in addition to coronary-cameral fistula, also includes aortoventricular tunnel and ruptured sinus of Valsalva aneurysm. Timely and appropriate diagnosis and surgical management resulted in preserved patency of the right coronary artery and restoration of normal right ventricular function.
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Affiliation(s)
- Megan Daniel
- Center for Pediatric and Congenital Heart Diseases, Cleveland Clinic, Cleveland, OH, USA
| | - Constantine Mavroudis
- Center for Pediatric and Congenital Heart Diseases, Cleveland Clinic, Cleveland, OH, USA
| | - Tamar Preminger
- Center for Pediatric and Congenital Heart Diseases, Cleveland Clinic, Cleveland, OH, USA
| | - Richard O. Lorber
- Center for Pediatric and Congenital Heart Diseases, Cleveland Clinic, Cleveland, OH, USA
| | - Marshall L. Jacobs
- Center for Pediatric and Congenital Heart Diseases, Cleveland Clinic, Cleveland, OH, USA
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Kang JK, Huh JH, Chang JM, Song CM. Right Coronary Artery to Left Ventricular Fistula with a Giant Right Coronary Artery Aneurysm. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2010. [DOI: 10.5090/kjtcs.2010.43.3.296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Joon Kyu Kang
- Department of Thoracic and Cardiovascular Surgery, Sanggye Paik Hospital, Inje University
| | - Jae-Hak Huh
- Department of Thoracic and Cardiovascular Surgery, Sanggye Paik Hospital, Inje University
| | - Ji-Min Chang
- Department of Thoracic and Cardiovascular Surgery, Sanggye Paik Hospital, Inje University
| | - Cheol-Min Song
- Department of Thoracic and Cardiovascular Surgery, National Police Hospital
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Singhal P, Liang M, Devlin G, Ullal R. Congenital Left Main Coronary Artery to Main Pulmonary Artery Fistula with Bicuspid Aortic Valve: A Case Report and Review of Literature. J Card Surg 2010; 25:295-9. [DOI: 10.1111/j.1540-8191.2010.01016.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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21
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Murphy BP, Gilbert T. Case report: coronary steal secondary to a left main coronary artery-pulmonary artery fistula only manifest after coronary artery bypass surgery. Int J Cardiol 2009; 137:e47-8. [PMID: 19410310 DOI: 10.1016/j.ijcard.2009.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2009] [Accepted: 04/01/2009] [Indexed: 11/29/2022]
Abstract
We report the case of a 64 year old man with two vessel coronary artery disease and a left main coronary artery to pulmonary artery fistula. He underwent coronary artery bypass grafting, but the coronary artery fistula was not closed. He developed recurrent angina due to coronary steal from the distal left anterior descending artery by the maturing coronary artery fistula. This was closed percutaneously by stenting the left main coronary artery with covered stents. The clinical implications and potential mechanisms of the coronary steal due to the coronary artery fistula are discussed.
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22
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Jung HS, Lee TK, Bae W, Yun CS, Park CH, Jang JB. Communicating bilateral coronary artery to pulmonary artery fistula with aneurysms. Int J Cardiol 2009; 149:e75-e77. [PMID: 19406490 DOI: 10.1016/j.ijcard.2009.03.132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2009] [Accepted: 03/30/2009] [Indexed: 11/24/2022]
Abstract
Bilateral coronary artery to pulmonary artery fistula is very rare. We describe a 70-year-old female patient with communicating bilateral coronary artery to pulmonary artery fistula identified on coronary angiography and coronary computed tomography angiography.
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Affiliation(s)
- Hoon Sik Jung
- Department of Diagnostic Radiology, Bongsaeng Memorial Hospital, Busan, Republic of Korea.
| | - Tae Kun Lee
- Department of Cardiology, Bongsaeng Memorial Hospital, Busan, Republic of Korea
| | - WooHyeong Bae
- Department of Cardiology, Bongsaeng Memorial Hospital, Busan, Republic of Korea
| | - Chi Sun Yun
- Department of Diagnostic Radiology, Bongsaeng Memorial Hospital, Busan, Republic of Korea
| | - Chung Hun Park
- Department of Diagnostic Radiology, Bongsaeng Memorial Hospital, Busan, Republic of Korea
| | - Jin Bae Jang
- Department of Diagnostic Radiology, Bongsaeng Memorial Hospital, Busan, Republic of Korea
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23
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Choi CU, Kim JW, Yong HS, Suh SY, Kim EJ, Rha SW, Park CG, Seo HS, Oh DJ. Bilateral coronary artery fistula and communication between two fistulas identified on multidetector computed tomography in patient with coronary artery disease. Int J Cardiol 2008; 127:e118-21. [PMID: 17643509 DOI: 10.1016/j.ijcard.2007.04.108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2007] [Accepted: 04/23/2007] [Indexed: 12/20/2022]
Abstract
In this case report, we describe a 59-year-old man with stentotic lesion of mid LAD and connection of bilateral coronary artery to pulmonary artery with some communications between two fistulas identified on multidetector computed tomography.
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Aoyagi S, Fukunaga S, Ishihara K, Egawa N, Hosokawa Y, Nakamura E. Coronary artery fistula from the left circumflex to the coronary sinus. Int Heart J 2007; 47:147-52. [PMID: 16479050 DOI: 10.1536/ihj.47.147] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A 27-year-old woman, who had received mitral valve repair for mitral regurgitation resulting from infective endocarditis, was admitted for a close examination of abnormal echocardiographic findings in the left atrium. Transthoracic echocardiography showed trivial mitral regurgitation with normal left ventricular contraction and dilatation of the coronary sinus. Auscultation revealed a grade 2 continuous murmur along the left sternal border. Transesophageal echocardiography demonstrated a marked dilatation of the coronary sinus just behind the posterior wall of the left atrium and turbulent blood flow in the dilated coronary sinus. Cardiac catheterization showed no significant step-up of oxygen saturation in the right heart and normal pulmonary artery pressure. Coronary angiography revealed a markedly dilated and tortuous circumflex coronary artery connected to the coronary sinus through a fistula. A left circumflex artery with a fistulous connection to the coronary sinus is extremely rare.
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Affiliation(s)
- Shigeaki Aoyagi
- Department of Surgery, Kurume University School of Medicine, Kurume, Japan
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25
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Left circumflex coronary artery fistula to the superior vena cava: assessment of the exact anatomy by multidetector CT. Clin Res Cardiol 2007; 97:272-6. [PMID: 18046521 DOI: 10.1007/s00392-007-0620-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2007] [Accepted: 10/22/2007] [Indexed: 01/06/2023]
Abstract
A 62-year-old woman with mild dyspnea on exertion underwent coronary angiography. A large fistula of the left circumflex artery was found but the exit site of this unusual anomaly could not be established. Contrast-enhanced multidetector computed tomography of the coronary arteries was performed which allowed clear identification of the drainage of the fistula into the superior vena cava.
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26
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Charokopos N, Rouska E, Antonitsis P, Spanos P. Successful repair of a huge right coronary artery to a right ventricular fistula: report of a case. Surg Today 2007; 37:664-6. [PMID: 17643210 DOI: 10.1007/s00595-006-3425-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2006] [Accepted: 11/07/2006] [Indexed: 11/28/2022]
Abstract
Congenital coronary artery fistulas account for only 0.27%-0.4% of all congenital cardiac defects. We report a case of a right coronary artery (RCA) to a right ventricular(RV) fistula found in 14-year-old girl with clinical signs of heart failure. Echocardiography and cardiac catheterization showed the fistula and a dilated RCA with a diameter of 10 mm. Operative intervention was required, so we performed intracardiac closure of the ventricular fistulous opening under cardiopulmonary bypass (CPB). The patient recovered uneventfully. This method of closure spares the involved coronary artery and is associated with a low risk of recurrence or residual fistula.
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Affiliation(s)
- Nicholas Charokopos
- First Department of Thoracic and Cardiovascular Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Jung C, Jorns C, Huhta J. Doppler findings in a rare coronary artery fistula. Cardiovasc Ultrasound 2007; 5:10. [PMID: 17349031 PMCID: PMC1828047 DOI: 10.1186/1476-7120-5-10] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2007] [Accepted: 03/09/2007] [Indexed: 11/15/2022] Open
Abstract
One of the primary forms of congenital anomalies of the coronary arteries is coronary artery fistula (CAF). It is defined as a direct communication between the coronary artery and any surrounding cardiac chamber or vascular structure, which bypasses the myocardial capillary bed. We present a newborn baby with a large coronary artery fistula connecting the left anterior descending (LAD) artery to the left ventricular (LV) apex. Associated cardiac abnormalities were found: a ventricular septal defect (diameter 4 mm), a patent foramen ovale as well as trivial tricuspid and mitral regurgitation. Here we demonstrate the echocardiograms of an extremely rare form of CAF diagnosed within the first days of postnatal life.
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Affiliation(s)
- Christian Jung
- Pediatric Cardiology, All Children's Hospital, University of South Florida, 801 6Street South, St. Petersburg, FL 33701, USA
- Department of Internal Medicine, I Division of Cardiology, University of Jena, Erlanger Allee 101, 07747 Jena, Germany
| | - Carl Jorns
- Pediatric Cardiology, All Children's Hospital, University of South Florida, 801 6Street South, St. Petersburg, FL 33701, USA
| | - James Huhta
- Pediatric Cardiology, All Children's Hospital, University of South Florida, 801 6Street South, St. Petersburg, FL 33701, USA
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