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Rivera Boadla ME, Sharma NR, Gulati A, Khurana S, Khan MH, Batool A, Farooqui AA, Cabrera JS, Aparicio Recarte T, Hashmi AT. Unlocking the Hidden Pathway: A Rare Encounter With Right Coronary Artery Fistula to Coronary Sinus and Right Ventricle. Cureus 2024; 16:e59155. [PMID: 38803750 PMCID: PMC11129799 DOI: 10.7759/cureus.59155] [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: 04/25/2024] [Indexed: 05/29/2024] Open
Abstract
Coronary artery fistulas (CAFs) are rare vascular anomalies characterized by abnormal connections between coronary arteries and cardiac chambers or adjacent structures. Advances in cardiac interventions have led to an increasing recognition of acquired CAFs, which are typically congenital. We present a case of a 62-year-old male with a complex medical history, including hypertension, atrial fibrillation, and heart failure, who presented with exertional chest pain and palpitations. Diagnostic evaluation revealed a significant CAF originating from the right coronary artery (RCA) and terminating into the coronary sinus and right ventricle. Despite the absence of significant coronary artery occlusions, the fistula was deemed clinically significant due to its potential to cause myocardial ischemia. Management involved guideline-directed medical therapy and lifestyle modifications. This case underscores the importance of early recognition and appropriate management of CAFs to optimize patient outcomes. Further research is needed to better understand the natural history and optimal management strategies of CAFs.
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Affiliation(s)
| | - Nava R Sharma
- Internal Medicine, Maimonides Medical Center, Brooklyn, USA
- Medicine, Manipal College of Medical Science, Pokhara, NPL
| | - Amit Gulati
- Cardiology, Icahn School of Medicine at Mount Sinai, New York, USA
| | | | | | - Asiya Batool
- Internal Medicine, Jinnah Hospital, Allama Iqbal Medical College (AIMC), Lahore, PAK
| | | | - Juan S Cabrera
- Medicine, Universidad Tecnológica Centroamericana (UNITEC), Tegucigalpa, HND
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2
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Wu S, Fares M, Zellers TM, Jyothinagaram M, Reddy SRV. Diagnosis and Management of Congenital Coronary Artery Fistulas in Infants and Children. Curr Cardiol Rep 2023; 25:1921-1932. [PMID: 38051412 DOI: 10.1007/s11886-023-02007-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/26/2023] [Indexed: 12/07/2023]
Abstract
PURPOSE OF REVIEW Coronary artery fistulas (CAFs) are rare coronary anomalies that most often occur as congenital malformations in children. Although most children with CAFs are asymptomatic at the time of diagnosis, some present with symptoms of congestive heart failure in the setting of large left-to-right shunts. Others may develop additional complications including coronary artery ectasia and coronary thrombosis. Surgical and transcatheter closure techniques have been previously described. This review presents the classifications of CAFs in children and the short and long-term outcomes of CAF closure in children in the reported literature. We also summarize previously-reported angiographic findings and post-treatment remodeling characteristics in pediatric patients. RECENT FINDINGS With advancements in cross-sectional imaging technologies, anatomic delineation of CAFs via these modalities has become crucial in procedural planning. Recent reports of surgical and transcatheter closure of CAFs in children have reported good procedural success and low rates of short-term morbidity and mortality. Distal-type CAFs have elevated risk for long-term sequelae post-closure compared to proximal-type CAFs. A recent report of a multi-institutional cohort also describes post-closure remodeling classifications which may predict long-term outcomes in these patients as well as guide individualized anticoagulation management. Invasive closure of significant CAFs via surgical or transcatheter techniques is feasible and safe in most children with good short and intermediate-term outcomes. However, close clinical and imaging follow-up is required to monitor for late complications even after successful closure. Antiplatelet and anticoagulation regimens remain important aspects of post-closure management, but the necessary intensity and duration of such therapy remains unknown.
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Affiliation(s)
- Stephan Wu
- Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Children's Health System of Texas, Childrens Medical Center, 1935 Medical District Drive, Dallas, TX, 75235, USA.
| | - Munes Fares
- Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Children's Health System of Texas, Childrens Medical Center, 1935 Medical District Drive, Dallas, TX, 75235, USA
| | - Thomas M Zellers
- Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Children's Health System of Texas, Childrens Medical Center, 1935 Medical District Drive, Dallas, TX, 75235, USA
| | - Maanya Jyothinagaram
- Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Children's Health System of Texas, Childrens Medical Center, 1935 Medical District Drive, Dallas, TX, 75235, USA
| | - Surendranath R Veeram Reddy
- Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Children's Health System of Texas, Childrens Medical Center, 1935 Medical District Drive, Dallas, TX, 75235, USA
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3
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Kumar R, Kumar J, O'Connor C, Ullah I, Tyrell B, Pearson I, Matiullah S, Bainey K. Coronary Artery Fistula: A Diagnostic Dilemma. Interv Cardiol 2023; 18:e25. [PMID: 38125927 PMCID: PMC10731518 DOI: 10.15420/icr.2022.34] [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] [Received: 11/05/2022] [Accepted: 06/01/2023] [Indexed: 12/23/2023] Open
Abstract
Coronary artery fistula (CAF), although one of the rare coronary anomalies, is becoming increasingly more detectable in the recent years due to advancements in cardiac diagnostic imaging. Its long-term prognostic implications and importance for the cardiovascular system remain a dilemma for cardiologists and patients. Based on a variety of haemodynamic symptoms and complications, cardiologists must be aware of the characteristics of CAF and the diagnostic importance of multi-slice CT in evaluation, pre-procedural management and follow-up. Both surgical and percutaneous options are available for symptomatic patients or those with complications, while management of asymptomatic CAF remains a viable alternative.
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Affiliation(s)
- Rajesh Kumar
- Department of Cardiology, St James’s HospitalDublin, Ireland
- Mazankowski Alberta Heart Institute, University of Alberta HospitalEdmonton, Canada
| | - Jathinder Kumar
- Department of Cardiology, St James’s HospitalDublin, Ireland
| | - Cormac O'Connor
- Department of Cardiology, St James’s HospitalDublin, Ireland
| | - Ihsan Ullah
- Department of Cardiology, St James’s HospitalDublin, Ireland
| | - Benjamin Tyrell
- Mazankowski Alberta Heart Institute, University of Alberta HospitalEdmonton, Canada
| | - Ian Pearson
- Department of Cardiology, St James’s HospitalDublin, Ireland
| | | | - Kevin Bainey
- Mazankowski Alberta Heart Institute, University of Alberta HospitalEdmonton, Canada
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4
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Lau WR, Lee PT, Koh CH. Coronary Artery Anomalies - State of the Art Review. Curr Probl Cardiol 2023; 48:101935. [PMID: 37433414 DOI: 10.1016/j.cpcardiol.2023.101935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/04/2023] [Indexed: 07/13/2023]
Abstract
Coronary artery anomalies (CAAs) comprise a wide spectrum of anatomic entities, with diverse clinical phenotypes. We present a case of an anomalous right coronary artery arising from the left aortic sinus with an interarterial course, a potentially fatal condition that can precipitate ischemia and sudden cardiac death. CAAs are increasingly detected in adults, mostly as incidental findings in the course of cardiac evaluation. This is due to the expanding use of invasive and noninvasive cardiac imaging, usually in the work-up for possible CAD. The prognostic implications of CAAs in this group of patients remain unclear. In AAOCA patients, appropriate work-up with anatomical and functional imaging should be performed for risk stratification. An individualized approach to management should be adopted, considering symptoms, age, sporting activities and the presence of high-risk anatomical features and physiologic consequences (such as ischemia, myocardial fibrosis, or cardiac arrhythmias) detected on multimodality imaging or other functional cardiac investigations. This comprehensive and up to date review seeks to crystallize current data in the recent literature, and proposes a clinical management algorithm for the clinician faced with the conundrum of managing such conditions.
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Affiliation(s)
- Wei Ren Lau
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Phong Teck Lee
- Department of Cardiology, National Heart Centre Singapore, Singapore; Duke-NUS School of Medicine, National University of Singapore, Singapore
| | - Choong Hou Koh
- Department of Cardiology, National Heart Centre Singapore, Singapore; Duke-NUS School of Medicine, National University of Singapore, Singapore; Changi Aviation Medical Centre, Changi General Hospital, Singapore.
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5
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Tang W, Xiang K, Zhou H, Li Y, Yang J, Liu J, Fan C. Case report: Surgical management of a rare right coronary artery fistula with a giant pseudoaneurysm compressing the pulmonary vein in a young patient. Front Cardiovasc Med 2023; 10:1233873. [PMID: 37781309 PMCID: PMC10535103 DOI: 10.3389/fcvm.2023.1233873] [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] [Received: 06/02/2023] [Accepted: 08/15/2023] [Indexed: 10/03/2023] Open
Abstract
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.
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Affiliation(s)
| | | | | | | | | | - Jijia Liu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
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Sriramoju A, Suppah M, Chao CJ, Sorajja D, Sweeney J, Naidu S, Lee R. Sinus Node Dysfunction After Percutaneous Transcatheter Closure of Right Coronary Artery-Superior Vena Cava Fistula. JACC Case Rep 2023; 16:101890. [PMID: 37396315 PMCID: PMC10313493 DOI: 10.1016/j.jaccas.2023.101890] [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] [Received: 12/26/2022] [Revised: 04/25/2023] [Accepted: 05/02/2023] [Indexed: 07/04/2023]
Abstract
Congenital right coronary artery-superior vena cava (RCA-SVC) fistula is rare and typically does not manifest any symptoms until the fifth decade of life. The present case demonstrates a 48-year-old woman who developed Sinus node dysfunction of unknown cause after Percutaneous coil embolization of the RCA-SVC fistula requiring permanent pacemaker. (Level of Difficulty: Intermediate.).
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Affiliation(s)
| | | | | | | | | | | | - Richard Lee
- Address for correspondence: Dr Richard Lee, Division of Cardiovascular Diseases, Mayo Clinic Hospital, 5777 East Mayo Boulevard, Phoenix, Arizona 85054, USA.
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An atypical cause of chest pain. Cardiol Young 2022; 32:1839-1841. [PMID: 35179107 DOI: 10.1017/s1047951122000476] [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: 11/06/2022]
Abstract
Congenital coronary artery anomalies are of major significance in clinical cardiology and cardiac surgery due to their association with myocardial ischaemia and sudden death. Having a multidisciplinary approach in managing complex congenital conditions and including patients in the management decisions is essential for good doctor-patient relationship. Here within, we describe a complex coronary artery fistula leading to myocardial steal.
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8
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Sharifkazemi M, Mohseni-Badalabadi R, Hosseinsabet A, Hajizeinali A. Case report: Multimodal imaging diagnosis of a giant coronary artery fistula: A report of two cases. Front Cardiovasc Med 2022; 9:986078. [PMID: 36386328 PMCID: PMC9644096 DOI: 10.3389/fcvm.2022.986078] [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: 07/04/2022] [Accepted: 10/12/2022] [Indexed: 11/29/2022] Open
Abstract
Being a very rare cardiac disease, most cases of coronary artery fistula (CAF) are genetic. Complications such as coronary steal syndrome, myocardial infarction, heart failure, or tamponade can manifest following the abnormal communication that the fistula creates between the coronary arteries and cardiac chambers or major vessels and the subsequent shunt. Most CAFs are small and asymptomatic, making diagnosis difficult. In symptomatic patients, the initial diagnostic workup is generally made with chest radiography and electrocardiography. Other imaging modalities have also been suggested to improve diagnostic accuracy. Cardiac catheterization and coronary angiography are currently the gold standard for diagnosis and planning the intervention, as they can recognize the quantum of the shunt as well as complications of a fistulous track (e.g., aneurysm formation, thrombus, leak, and the number of openings to the receiving chamber/vessel); however, this invasive method may be associated with risk. Herein, we report two patients with giant CAFs, one from the left circumflex artery to the coronary sinus and the other to the superior vena cava. Moreover, we describe how multimodal imaging, including two- and three-dimensional transesophageal echocardiography, coronary cineangiography, coronary computed tomography angiography, and enhanced chest computed tomography, can facilitate diagnosis and estimate the disease course in such patients. We believe that using multimodal imaging cannot only help the initial diagnosis regarding the presence of a CAF and the accurate anatomical site of the fistula in the patient but can also help predict the disease course and choose the most suitable treatment modality. Therefore, we suggest multimodal imaging be done to diagnose patients suspected of CAF. However, invasive cineangiography should be necessarily followed, regardless of whether an intervention is planned or not.
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Affiliation(s)
- Mohammadbagher Sharifkazemi
- Department of Cardiology, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
- *Correspondence: Mohammadbagher Sharifkazemi,
| | - Reza Mohseni-Badalabadi
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Hosseinsabet
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alimohammad Hajizeinali
- Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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9
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Özcan S, Mert B, Güner A, İnce O, Okuyan E. Giant fibrotic sac of the right coronary artery. Coron Artery Dis 2021; 33:339-340. [PMID: 34919061 DOI: 10.1097/mca.0000000000001116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Sevgi Özcan
- Department of Cardiology, Bağcilar Training and Research Hospital, Istanbul Department of Cardiovascular Surgery, Bağcilar Training and Research Hospital, Istanbul Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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10
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Taskesen T, Osei K, Hamilton R, Ugwu J, Shivapour D, Tannenbaum M, Ghali M. Coronary Artery Fistulae in Adult: Two Decades of Experience in Clinical Presentation, Angiographic Feature, and Management. Int J Angiol 2021; 30:277-284. [PMID: 34853575 DOI: 10.1055/s-0041-1727134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Coronary artery fistula (CAF) in adults is a rare but significant coronary artery anomaly. Main data on that rare disease were mostly obtained from case reports and small studies. In presented study, we share our two-decade experience on the clinical and angiographic characteristics of CAF. The data were collected retrospectively by analyzing the angiographic data between January 1, 2000 and December 31, 2019. Demographic data, clinical data, laboratory, and cardiac catheterization reports were reviewed. CAFs were found in 40 patients (0.06%). There were 22 male (55%) patients. The mean age was 61.2 years. Twenty-nine patients (72.5%) had small, 4 patients (10%) had medium, and 7 patients (17.5%) had large CAFs. The majority of study population had solitary CAF ( n = 31, 77.5%). The pulmonary artery is the major side of fistula drainage ( n = 20, 50%). The study population was divided into two groups as follow: group 1-small CAFs 29 (72.5%), group 2-medium and large CAF (MLCAF) 11 (27.5%). Patients with MLCAFs had more atrial fibrillation, abnormal coronary morphology, and multiple fistulae. In patients with hemodynamically significant CAFs, 7 (17.5%) patients had surgical ligation and 3 (7.5%) patients had transcutaneous closure. Three patients died during mean follow-up period of 5 years. The incidence and the pattern of CAFs in our study were similar to previous studies. Clinical course of small fistulae was benign. Symptomatic MLCAFs need to be treated by transcatheter or surgical way and should be individualized per patient.
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Affiliation(s)
- Tuncay Taskesen
- Division of Cardiology, MercyOne-Iowa Heart Center, Des Moines, Iowa
| | - Kofi Osei
- Division of Cardiology, MercyOne-Iowa Heart Center, Des Moines, Iowa
| | - Russell Hamilton
- Division of Cardiology, MercyOne-Iowa Heart Center, Des Moines, Iowa
| | - Justin Ugwu
- Division of Cardiology, MercyOne-Iowa Heart Center, Des Moines, Iowa
| | - Daniel Shivapour
- Division of Cardiology, MercyOne-Iowa Heart Center, Des Moines, Iowa
| | - Mark Tannenbaum
- Division of Cardiology, MercyOne-Iowa Heart Center, Des Moines, Iowa
| | - Magdi Ghali
- Division of Cardiology, MercyOne-Iowa Heart Center, Des Moines, Iowa
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11
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Abstract
Coronary artery fistulas are uncommon but clinically important entities that may produce symptoms and significant complications such as angina, myocardial infarction, coronary artery aneurysm formation, and congestive heart failure. Multiple fistula types have been recognized, and classification uses factors such as etiology, coronary artery origin, and drainage site. Both invasive and noninvasive imaging play an important role in the management and treatment of these patients, and often times, more than one modality is necessary for comprehensive evaluation of coronary fistulas. Recent advances in both functional and anatomic imaging will likely also play a growing role in fistula evaluation. The purpose of this article is to review the classification, pathophysiology, clinical presentations, imaging findings, treatment, and future imaging directions of coronary artery fistulas.
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12
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Adam EL, Generoso G, Bittencourt MS. Anomalous Coronary Arteries: When to Follow-up, Risk Stratify, and Plan Intervention. Curr Cardiol Rep 2021; 23:102. [PMID: 34196813 DOI: 10.1007/s11886-021-01535-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/17/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Coronary artery anomalies are a diverse group of entities, ranging from benign variations of normal anatomy to life-threatening conditions. There is, however, no universal consensus in their classification, risk stratification, and management. The aim of this review is to develop a straightforward clinical approach for the assessment and care of patients with anomalous coronary arteries. RECENT FINDINGS Autopsy series and population screening studies have recently provided useful clinical data on the prevalence and outcomes of coronary anomalies. Also, findings on coronary computed tomography angiography, magnetic resonance imaging, and invasive angiography, enriched with fractional flow reserve and intravascular ultrasound, have allowed identification of several high-risk features associated with specific coronary anomalies. Management of patients with anomalous coronary arteries requires an individualized approach based on clinical, physiological, and anatomic features. High-quality studies are paramount for further development of this fascinating field.
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Affiliation(s)
| | - Giuliano Generoso
- University Hospital, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Marcio Sommer Bittencourt
- University Hospital, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
- DASA, Sao Paulo, Brazil.
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13
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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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14
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Bao Y, Xiong TY, Li X, Feng Y. Percutaneous closure of a fistula from the left circumflex coronary artery to the coronary sinus in an infant. J Int Med Res 2021; 49:3000605211021732. [PMID: 34111997 PMCID: PMC8202310 DOI: 10.1177/03000605211021732] [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: 02/05/2023] Open
Abstract
Coronary artery fistula is an abnormal direct connection between the coronary artery and any of the four chambers of the heart or great vessels. A fistula from the left circumflex coronary artery to the coronary sinus is a relatively rare situation. We report a case of 12-month-old infant with coronary artery fistula from the left circumflex coronary artery to the coronary sinus that was identified incidentally. The N-terminal pro-brain natriuretic peptide level was elevated. Additionally, the proximal segment of the left circumflex coronary artery was dilated. On the basis of these findings, percutaneous closure of the fistula was performed with a vascular plug. This procedure achieved no residual flow and good hemodynamics were observed during follow-up.
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Affiliation(s)
- Yun Bao
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Tian-Yuan Xiong
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiao Li
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yuan Feng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
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15
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Truong T, Nguyen HTT, Phan VTX, Ly MHP, Phan VTT, Phan TA, Phan HH, Tran P. A case report of coronary pulmonary artery fistula detected by transthoracic echocardiography in an elderly patient with dyspnea. AME Case Rep 2021; 5:10. [PMID: 33623864 DOI: 10.21037/acr-20-100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 11/25/2020] [Indexed: 11/06/2022]
Abstract
Coronary pulmonary artery fistula (CPAF) is a rare entity in the population. It may present with multiple clinical settings and in various age ranges. Invasive coronary angiography (ICA), coronary computed tomography angiography (CCTA), and transthoracic echocardiography (TTE) have been reported as diagnostic tools for CPAF. Among them, TTE is rarely capable of identifying CPAF. There is no current treatment guideline as some of the interventional therapies are effective yet controversial. The therapy therefore should be individualized. We report a case of CPAF accidentally detected by TTE in a 93-year-old female who presented with acute respiratory distress on the setting of community-acquired pneumonia, diastolic heart failure, ischemic heart disease, pulmonary hypertension, chronic kidney disease, and hypertension. The patient presented with orthopnea, fever, bilateral pleuritic chest pain, and productive cough with yellowish sputum for 7 days. She had no previous chest trauma or surgical intervention. TTE demonstrated the tortuous enlargement of left coronary artery which drains into the pulmonary arterial trunk right above the pulmonary valve. As the patient was in advanced age with multiple comorbidities; we offered a conservative management including diuretic, oxygen therapy, antibiotic, antiplatelet, and statin. She recovered following a 13-day hospitalization. To our knowledge, this is the oldest case report of suspected congenital CPAF which is particularly detected by TTE.
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Affiliation(s)
- Thai Truong
- Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | | | | | | | | | - Tu Anh Phan
- Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Hannah Hue Phan
- University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Phillip Tran
- Nam Can Tho University, School of Medicine, Can Tho, Vietnam
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16
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Semerdzhieva NE, Denchev S. Coronary Flow in Patients With Myocardial Bridges, Coronary Fistulae in the Setting of Unstable Non-Obstructive Coronary Disease. Cureus 2021; 13:e13130. [PMID: 33728147 PMCID: PMC7936646 DOI: 10.7759/cureus.13130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Оbjective Our aim was to describe the difference in epicardial coronary flow at baseline on background anti-ischaemic therapy and following intracoronary glyceryl trinitrate in patients with acute coronary syndrome and non-obstructive coronary disease with and without myocardial bridges and coronary artery fistulae. Materials and methods Coronary flow was characterized in a group of 88 patients with coronary stenoses <50% diagnosed with acute coronary syndrome using the corrected Thrombolysis in Myocardial Infarction frame count (cTFC) method at coronary angiography at baseline and after the application of 200 µg glyceryl trinitrate. Results Тhe patients with myocardial bridges and coronary artery fistulae accounted for 4.4% (n=4) and 2.2% (n=2), respectively, of the patients with acute coronary syndrome. Sixty-two (70%) of all patients demonstrated slow progression of the contrast media (cTFC>25 frames) in at least one coronary artery. Coronary flow was similarly impaired in the patients with myocardial bridges, coronary artery fistulae, and those without coronary anomalies and variants. After the intracoronary infusion of glyceryl trinitrate, the epicardial flow improved in the patients with myocardial bridges and to a lesser degree in the cases with coronary fistulae. Most of the patients who responded to glyceryl trinitrate were on background therapy with calcium channel blockers. Conclusion The epicardial coronary flow of patients with non-obstructive coronary disease with myocardial bridges and acute coronary syndrome showed less impairment compared to baseline in response to intracoronary glyceryl trinitrate applied at background anti-ischaemic therapy that included calcium channel blockers.
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Durães Campos I, Costa J, Azevedo P, Marques J. A very rare case of myocardial ischaemia. BMJ Case Rep 2020; 13:13/12/e239639. [PMID: 33334772 PMCID: PMC7747544 DOI: 10.1136/bcr-2020-239639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Affiliation(s)
| | - João Costa
- Cardiology Department, Hospital de Braga, Braga, Portugal
| | - Pedro Azevedo
- Cardiology Department, Hospital de Braga, Braga, Portugal
| | - Jorge Marques
- Cardiology Department, Hospital de Braga, Braga, Portugal
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Tang L, Wang ZJ, Tang JJ, Fang ZF, Hu XQ, Tai S, Xing ZH, Shen XQ, Zhao YS, Zhou SH. Transcatheter Closure of Large Coronary-Cameral Fistulas Using the Patent Ductus Arteriosus Occluder or Amplatzer Vascular Plugs. Int Heart J 2020; 61:1220-1228. [PMID: 33191343 DOI: 10.1536/ihj.20-169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Transcatheter closure (TCC) has emerged as the first-line treatment for coronary artery fistulas. However, limited data exist regarding the long-term outcomes and technical aspects of this procedure. We aimed to report the long-term outcomes and technical aspects of TCC of large coronary-cameral fistulas (CCFs).All patients with large CCFs who underwent attempted TCC using the patent ductus arteriosus (PDA) occluder or Amplatzer vascular plug (AVP), from June 2002 to December 2017, were retrospectively reviewed. A total of 23 patients with large CCFs underwent attempted TCC using the PDA occluder or AVP. Most CCFs originated from the right coronary artery and drained predominantly into the right heart chamber. Procedural success was achieved in 21 (91.3%) patients. Devices were deployed using the arteriovenous loop in 15, transarterial approach in 4, and arterio-artery loop approach in 2 patients. Procedural complications included coronary spasm in one and side branch occlusion in one patient. Among these 21 patients with successful device implantation, follow-up angiograms or computed tomography angiograms were obtained in 14 (66.7%) patients at a median of 11.0 (range, 9.8-16.3) months. Late complications included thrombosis of residual fistula segment without myocardial infarction (MI) in one, coronary thrombosis resulting in MI in one, and recanalization necessitating re-intervention in one patient. No death and device embolization occurred.TCC of large CCFs using the PDA occluder or AVP is an effective therapy in anatomically suitable candidates, with favorable long-term outcomes. Given that potentially hazardous complications may occur late after the procedure, long-term periodic evaluation is mandatory.
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Affiliation(s)
- Liang Tang
- Department of Cardiology, The Second Xiangya Hospital of Central South University
| | - Zhao-Jun Wang
- Department of Cardiology, The Second Xiangya Hospital of Central South University
| | - Jian-Jun Tang
- Department of Cardiology, The Second Xiangya Hospital of Central South University
| | - Zhen-Fei Fang
- Department of Cardiology, The Second Xiangya Hospital of Central South University
| | - Xin-Qun Hu
- Department of Cardiology, The Second Xiangya Hospital of Central South University
| | - Shi Tai
- Department of Cardiology, The Second Xiangya Hospital of Central South University
| | - Zhen-Hua Xing
- Department of Cardiology, The Second Xiangya Hospital of Central South University
| | - Xiang-Qian Shen
- Department of Cardiology, The Second Xiangya Hospital of Central South University
| | - Yan-Shu Zhao
- Department of Cardiology, The Second Xiangya Hospital of Central South University
| | - Sheng-Hua Zhou
- Department of Cardiology, The Second Xiangya Hospital of Central South University
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Narh JT, Zahid E, Shivaraj K, Sahni S, Kariyanna PT, Khan A. Steal and strain: A case of coronary artery fistula presenting with coronary steal syndrome and underlying bronchiectasis. Respir Med Case Rep 2020; 31:101301. [PMID: 33318920 PMCID: PMC7724369 DOI: 10.1016/j.rmcr.2020.101301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 11/16/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Coronary artery fistula is a relatively rare disorder with an incidence rate of 0.05-0.9%, and the majority of fistulae are detected incidentally. Most coronary artery fistulae are congenital, and the acquired variant is very rare. Herein, we present a possible acquired coronary artery to pulmonary artery fistula, most likely secondary to bronchiectasis in the adjacent lung. We will analyze the hemodynamic significance of the fistula in this case and also seek to understand the outcomes of various treatment modalities. CASE PRESENTATION A 56-year-old male patient presented with hypoxemia secondary to acute pulmonary edema during a hypertensive emergency. He developed myocardial ischemia after treatment with diuretics and nitroglycerin, due to shunting of blood from the right coronary artery to the right lower lobe branch of the right pulmonary artery, via the fistula. This resulted in coronary steal syndrome. Coronary angiogram confirmed the fistula connecting the right coronary artery to the right lower lobe branch of the right pulmonary artery. An attempt at coil embolization was unsuccessful due to the inability to advance the microcatheter beyond the fistula. DISCUSSION The majority of coronary artery fistulae are asymptomatic as they are hemodynamically not significant and are incidentally detected by coronary angiography, CT angiogram, echocardiogram or multi-detector row computed tomography (MDCT) with 3D reconstruction. The development of congenital fistula can be explained by the Hackensellner involution-persistence hypothesis, but the anatomy in this case and the bronchiectasis in the part of the lung adjacent to the fistula makes an acquired cause very likely due to local inflammation and the age of patient at initial diagnosis. An initial diagnosis of bronchiectasis was made at age 51, which was 5 years prior to the detection of the coronary artery fistula in this patient. Symptoms have been described mostly in the elderly and include chest pain, dyspnea, fatigue, syncope, and palpitations. Such symptomatic fistula should be treated either by percutaneous transluminal embolization or surgical ligation. CONCLUSION This is a unique case of acquired coronary to pulmonary artery fistula in the setting of bronchiectasis in a patient in which PTE was attempted and failed. More research is required to understand the pathophysiology of acquired fistula. The decision regarding the method of closure should be individualized and decided on a case by case basis.
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Affiliation(s)
- Joshua Tetteh Narh
- Dept. of Internal Medicine, Brookdale Hospital Medical Center, Brooklyn, NY, USA
| | - Erum Zahid
- Dept. of Pulmonary and Critical Care Medicine, Brookdale Hospital Medical Center, Brooklyn, NY, USA
| | - Kiran Shivaraj
- Dept. of Internal Medicine, Brookdale Hospital Medical Center, Brooklyn, NY, USA
| | - Sonu Sahni
- Dept. of Internal Medicine, Brookdale Hospital Medical Center, Brooklyn, NY, USA
| | | | - Abdullah Khan
- Dept. of Cardiology, Brookdale Hospital Medical Center, Brooklyn, NY, USA
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20
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Knop GL, Madu E, Tulloch Reid E, Soliman A. Off pump surgical epicardial closure of left anterior descending to pulmonary artery fistula. J Cardiothorac Surg 2020; 15:306. [PMID: 33032638 PMCID: PMC7542878 DOI: 10.1186/s13019-020-01329-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/22/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Coronary artery fistulae (CAF) are rare anomalies. Left anterior descending(LAD) to Pulmonary artery (PA) CAF, represent a minority of cases. Large fistulas, create a significant shunt and a "steal phenomenon", and can lead to myocardial ischemia and heart failure (HF) if left untreated. CASE PRESENTATION We present a 57 years old female with a large LAD to PA fistulae. Given the rare occurrence and the predominance of low shunt of LAD to PA CAF, this case is functionally exceptional in this fistulae variant, causing a significant shunt which resulted in daily cardiac ischemic chest pain. Diagnosis work up included a nuclear stress test, Coronary Angiography and 3-D Coronary Computed Tomography Angiogram (CCTA). Traditionally, surgery has been the main therapy for symptomatic CAF, but transcatheter closure has emerged as a less invasive strategy and is a valuable alternative or even preferable if no associated cardiac conditions are present, provided the anatomical characteristics of the fistulae are appropriate. The surgical approach includes off pump epicardial interruption of the fistula or closure through a cardiac chamber (trans-cameral) or transpulmonary, or epicardial closure using Cardiopulmonary bypass. Caution must be taken in cases of CAF with Coronary Artery (CA) aneurysm in dominant CA, or drainage into the Coronary Sinus, as the possibility of ischemic complications are higher. Due to anatomical considerations and tortuosity of the fistulae, our patient was considered not amenable for percutaneous closure and surgery was opted. Epicardial closure of the fistula was performed on a beating heart, off pump. Outcome was favorable with complete resolution of ischemic symptoms. CONCLUSION Symptomatic, high shunt CAF must be interrupted. The presence of daily ischemic symptoms in our case report patient, is worth to be remarked. Alternatives for fistulae closure are transcatheter or surgery, depending on anatomic variables and the presence of associated cardiac conditions. Surgical epicardial closure of LAD to PA fistulae variant can be done with very low mortality and morbidity, but other variants with coronary aneurysm, drainage in the coronary sinus or other concomitant cardiac defects, may result in ischemic complications and higher perioperative mortality and worse long- term outcome.
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Affiliation(s)
- Gustavo L Knop
- Cardiothoracic Surgeon, FRCS, Heart Institute of the Caribbean, Kingston, Jamaica.
| | - Ernest Madu
- FACC, FESC, FRCP, Heart Institute of the Caribbean, Kingston, Jamaica
| | - Edwin Tulloch Reid
- Interventional Cardiologist, FACC, Heart Institute of the Caribbean, Kingston, Jamaica
| | - Ahmed Soliman
- Interventional Cardiologist, FESC, Heart Institute of the Caribbean, Kingston, Jamaica
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21
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Sandor B, Bogats G, Toth L, Habon T. Surgical treatment of heart failure due to giant coronary artery fistula: a case report. ESC Heart Fail 2020; 7:3203-3207. [PMID: 32700832 PMCID: PMC7524117 DOI: 10.1002/ehf2.12913] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 06/25/2020] [Accepted: 07/13/2020] [Indexed: 12/28/2022] Open
Abstract
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.
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Affiliation(s)
- Barbara Sandor
- Division of Cardiology, 1st Department of Internal Medicine, University of Pécs Medical School, Ifjúság Street 13, Pécs, 7624, Hungary
| | - Gabor Bogats
- Division of Heart Surgery, 2nd Department of Internal Medicine and Cardiology Center, Albert Szent-Györgyi Health Center, University of Szeged Faculty of Medicine, Szeged, Hungary
| | - Levente Toth
- Department of Medical Imaging, University of Pécs Medical School, Pécs, Hungary
| | - Tamas Habon
- Division of Cardiology, 1st Department of Internal Medicine, University of Pécs Medical School, Ifjúság Street 13, Pécs, 7624, Hungary
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22
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Ouchi K, Sakuma T, Ojiri H. Coronary artery fistula in adults: Incidence and appearance on cardiac computed tomography and comparison of detectability and hemodynamic effects with those on transthoracic echocardiography. J Cardiol 2020; 76:593-600. [PMID: 32636129 DOI: 10.1016/j.jjcc.2020.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/19/2020] [Accepted: 06/10/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The widespread use of cardiac computed tomography (CT) has increased the incidental discovery of fistulas of the coronary artery (CAF). This condition is rare and can affect hemodynamic parameters, but few reports focus on its hemodynamic effects. We investigated the frequency and types of CAF on CT and compared them with those of transthoracic echocardiography (TTE) to evaluate the detectability of CAF and its hemodynamic effects. MATERIALS AND METHODS We retrospectively evaluated cardiac CT images of 6789 adult patients who underwent imaging from January 1, 2013 through September 30, 2019 at our institution. We assessed the CT images for the presence of CAF and compared our findings with those obtained by TTE in control cases without CAF. RESULTS The prevalence of CAF determined with cardiac CT was 0.91%, with the left anterior descending artery (67.7%) as the most common site of origin and the main pulmonary artery (82.3%) as the most common origin of drainage. The incidence of aneurysm accompanying CAF was 48.4%. Color Doppler in TTE demonstrated abnormal flow that would suggest the presence of CAF of only 23.1%. Echocardiographic findings of hemodynamics did not differ significantly between patients with and without CAF nor between elderly and non-elderly patients with CAF. CONCLUSIONS Our study revealed differing prevalence and types of CAF from those reported using coronary angiography and little impact of CAF on hemodynamics. Color Doppler in TTE did not readily depict abnormal flow that might suggest the presence of a fistula, but cardiac CT allowed noninvasive and comprehensive assessment of CAF. Thus, we believe the acquisition of cardiac CT is necessary to establish the cause of continuous murmur that is not identified with TTE.
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Affiliation(s)
- Kotaro Ouchi
- Department of Radiology, The Jikei University School of Medicine, Tokyo, Japan.
| | - Toru Sakuma
- Department of Radiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroya Ojiri
- Department of Radiology, The Jikei University School of Medicine, Tokyo, Japan
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23
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Bagameri G, Crestanello JA. Commentary: When misdiagnosis leads to silver lining-a simple solution to the complex problem of congenital coronary artery fistula. JTCVS Tech 2020; 2:75-76. [PMID: 34317758 PMCID: PMC8298882 DOI: 10.1016/j.xjtc.2020.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 11/19/2022] Open
Affiliation(s)
| | - Juan A. Crestanello
- Address for reprints: Juan A. Crestanello, MD, Mayo Clinic, 200 First St SW, JO-5200, Rochester, MN 55905.
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24
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Koca Tari C, Erdol MA, Ilkay E. Printing the Procedure: Successful Closure of a Coronary Cameral Fistula With 3-Dimensional Model. JACC Case Rep 2020; 2:488-492. [PMID: 34317271 PMCID: PMC8311617 DOI: 10.1016/j.jaccas.2019.11.047] [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] [Received: 05/21/2019] [Revised: 10/24/2019] [Accepted: 11/20/2019] [Indexed: 06/13/2023]
Abstract
Cardiac 3-dimensional printing for pre-procedural planning of structural heart procedures is a promising new tool. Despite current potential drawbacks, 3-dimensional models can help cardiologists better understand and treat complex cardiac defects. We describe a successful coronary cameral fistula closure planned with the aid of a 3-dimensional model. (Level of Difficulty: Advanced.).
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Affiliation(s)
| | | | - Erdogan Ilkay
- Department of Cardiology, Liv Hospital Ankara, Ankara, Turkey
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25
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Le J, Deano RC, Raval AN. It hurts to swallow! Pseudoachalasia resulting from attempted transcatheter occlusion of a giant congenital coronary artery fistula. Catheter Cardiovasc Interv 2019; 94:980-983. [DOI: 10.1002/ccd.28539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 08/28/2019] [Accepted: 10/01/2019] [Indexed: 11/12/2022]
Affiliation(s)
- Jonathan Le
- Division of Cardiovascular Medicine, Department of Medicine University of Wisconsin School of Medicine and Public Health Madison Wisconsin
| | - Roderick C. Deano
- Division of Cardiovascular Medicine, Department of Medicine University of Wisconsin School of Medicine and Public Health Madison Wisconsin
| | - Amish N. Raval
- Division of Cardiovascular Medicine, Department of Medicine University of Wisconsin School of Medicine and Public Health Madison Wisconsin
- Department of Biomedical Engineering University of Wisconsin Madison Wisconsin
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Schicchi N, Fogante M, Oliva M, Schicchi F, Giovagnoni A. Bilateral coronary-to-pulmonary artery fistulas associated with giant aneurysm in an elderly woman: Case report and literature review. Radiol Case Rep 2019; 14:911-916. [PMID: 31193577 PMCID: PMC6536618 DOI: 10.1016/j.radcr.2019.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 04/29/2019] [Accepted: 04/30/2019] [Indexed: 01/02/2023] Open
Abstract
Coronary artery fistula is an abnormal vascular communication of coronary artery with cardiac chambers or any segment of the systemic or pulmonary circulation. The prevalence is 0.9% of all coronary anomalies. Coronary artery fistula arises from the right coronary artery in approximately 50.0% of patients, from left coronary artery in approximately 42.0% of patients, and from both in approximately 5.0% of patients. Low-pressure structures are the most common sites of drainage of the coronary fistulas. If a large left-to-right shunt exists, it can be associated with potential complications, such as arterial aneurysm. Here we report an extremely rare case of a 76-year-old woman with bilateral coronary-to-pulmonary artery fistulas associated with giant aneurysms, detected by coronary angiography and confirmed with coronary computed tomography.
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Affiliation(s)
- Nicolò Schicchi
- Radiology Department, Azienda Ospedaliero-Universitaria “Ospedali Riuniti”, Ancona 60126, Italy
| | - Marco Fogante
- Radiology Department, Azienda Ospedaliero-Universitaria “Ospedali Riuniti”, Ancona 60126, Italy
| | - Matteo Oliva
- Radiology Department, Azienda Ospedaliero-Universitaria “Ospedali Riuniti”, Ancona 60126, Italy
| | | | - Andrea Giovagnoni
- Radiology Department, Azienda Ospedaliero-Universitaria “Ospedali Riuniti”, Ancona 60126, Italy
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28
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Right Coronary Artery-Superior Vena Cava Fistula Manifesting as NSTEMI: Case Report, Review of Imaging, and Summary of Guidelines. AMERICAN JOURNAL OF MEDICAL CASE REPORTS 2019; 7:74-78. [PMID: 31396551 DOI: 10.12691/ajmcr-7-5-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Coronary artery fistulas (CAFs) represent a spectrum of abnormal connections between a coronary artery and another coronary artery, vein, or major blood vessel, known as coronary-vascular fistulas, or between a coronary artery and a cardiac chamber, known as coronary-cameral fistulas. While CAFs generally remain asymptomatic into the fifth decade of adult life, they can present with a diverse symptomatic profile, typically with angina from abnormal myocardial perfusion, or in the setting of larger fistulas, as right- or left-heart failure from pulmonary or left ventricular circulatory overload. CAFs rarely manifest as myocardial infarction in the absence of thrombosis within the fistula. When clinically suspected based on a continuous murmur on physical exam or an accidental finding on radiology, computed tomography angiography (CTA) and coronary angiography are the preferred diagnostic imaging modalities. Fistula anatomic and patient specific characteristics guide clinical decisions on transcatheter or surgical management strategies. We present the case of a right coronary artery-superior vena cava fistula manifesting as a non-ST elevation myocardial infarction. We also present a review of the imaging techniques available for evaluation of CAFs, and a summary of the major national and international cardiology society guidelines on the diagnosis and management of CAFs.
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29
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Manfredonia L, Genuardi L, Marano R, Rebuzzi AG, Buffon A, Burzotta F. Cardiogenic shock due to coronary fistula: a complex phenomenon. Minerva Cardioangiol 2019; 67:175-177. [DOI: 10.23736/s0026-4725.18.04734-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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30
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Jha NK, Kiraly L, Shah N, Al Mulla A, Mora B. Congenital aneurysmal right coronary artery with a fistula to the left atrium in an adult. J Cardiothorac Surg 2019; 14:33. [PMID: 30736865 PMCID: PMC6367818 DOI: 10.1186/s13019-019-0854-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 02/03/2019] [Indexed: 11/24/2022] Open
Abstract
Background Congenital coronary artery fistula in association with aneurysm of the involved coronary artery in adults is rare. Moreover, the right coronary artery- left atrial fistula is also uncommon. Most of the cases are asymptomatic. However, symptomatic patients need therapeutic interventions. The potential complications associated with this anomaly are life-threatening, therefore, there is a need to explore more on differential diagnosis, investigations, management strategies and prevention of complications. Case presentation We present herewith a 26-year-old male patient with symptoms of chest pain and dyspnea. He was diagnosed with aneurysmal dilatation of the right coronary artery in its entire course which terminated as a fistulous communication into the left atrium. The closure of the fistula was done using autologous pericardial patch under cardiopulmonary bypass. Currently, the patient is being followed up after surgery and receiving anticoagulants. Conclusion The advancement in the diagnostic imaging modalities have made it possible to find similar abnormalities more frequently. Due to rare nature of this anomaly, there is a need to explore and discuss management strategies that include medical management, surgical intervention or percutaneous interventions for a successful outcome.
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Affiliation(s)
- Neerod Kumar Jha
- Institute of Cardiac Sciences, PO BOX 51900, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates.
| | - Laszlo Kiraly
- Institute of Cardiac Sciences, PO BOX 51900, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Nishant Shah
- Institute of Cardiac Sciences, PO BOX 51900, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Arif Al Mulla
- Institute of Cardiac Sciences, PO BOX 51900, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Bassem Mora
- Institute of Cardiac Sciences, PO BOX 51900, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
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Krueger M, Cronin P, Sayyouh M, Kelly AM. Significant incidental cardiac disease on thoracic CT: what the general radiologist needs to know. Insights Imaging 2019; 10:10. [PMID: 30725202 PMCID: PMC6365314 DOI: 10.1186/s13244-019-0693-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 01/10/2019] [Indexed: 12/20/2022] Open
Abstract
Objective Incidental cardiac findings are often found on chest CT studies, some of which may be clinically significant. The objective of this pictorial review is to illustrate and describe the appearances and management of the most frequently encountered significant cardiac findings on non-electrocardiographically gated thoracic CT. Most radiologists will interpret multidetector chest CT and should be aware of the imaging appearances, significance, and the appropriate next management steps, when incidental significant cardiac disease is encountered on thoracic CT. Conclusion This article reviews significant incidental cardiac findings which may be encountered on chest CT studies. After completing this review, the reader should not only be familiar with recognizing clinically significant cardiac findings seen on thoracic CT examinations but also have the confidence to direct their further management.
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Affiliation(s)
- Maren Krueger
- Fulford Radiology, Base Hospital, Private Bag 2016, New Plymouth, Taranaki, 4342, New Zealand
| | - Paul Cronin
- Department of Radiology, Division of Cardiothoracic Radiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Mohamed Sayyouh
- Department of Radiology, Division of Cardiothoracic Radiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Aine Marie Kelly
- Department of Radiology, Division of Cardiothoracic Radiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA.
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Imaging of coronary artery fistulas by multidetector CT angiography using third generation dual source CT scanner. Clin Imaging 2019; 53:89-96. [DOI: 10.1016/j.clinimag.2018.09.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 09/05/2018] [Accepted: 09/24/2018] [Indexed: 11/18/2022]
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33
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Wattal S, Kareem H, Devasia T, Paramasivam G. Coronary artery fistula and mid-cavitary obstructive hypertrophic cardiomyopathy: a rare association. BMJ Case Rep 2018; 2018:bcr-2017-223174. [DOI: 10.1136/bcr-2017-223174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Yun G, Nam TH, Chun EJ. Coronary Artery Fistulas: Pathophysiology, Imaging Findings, and Management. Radiographics 2018; 38:688-703. [DOI: 10.1148/rg.2018170158] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Gabin Yun
- From the Department of Radiology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 436-707, Republic of Korea
| | - Tae Hyun Nam
- From the Department of Radiology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 436-707, Republic of Korea
| | - Eun Ju Chun
- From the Department of Radiology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 436-707, Republic of Korea
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Atik E, Leal F, Arrieta R. Case 2 / 2018 - Coronary-Cavitary Fistula of Right Ventricular Coronary Artery 5 Years after its Occlusion by Interventional Catheterization. Arq Bras Cardiol 2018; 110:289-291. [PMID: 29694550 PMCID: PMC5898780 DOI: 10.5935/abc.20180048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Edmar Atik
- Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Fidel Leal
- Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Raul Arrieta
- Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Li P, Xu X, Zhang Z, Wang F, Wang Z, Chen F, Zhang B, Qin Y, Chen S, Zhao X. Combined use of coils and Onyx for transcatheter closure of coronary artery fistulae. EUROINTERVENTION 2018; 13:e2130-e2137. [PMID: 29278350 DOI: 10.4244/eij-d-17-00632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this study was to evaluate the safety and efficacy of combined endovascular coiling and Onyx embolisation in patients with a coronary artery fistula (CAF). METHODS AND RESULTS Between September 2014 and September 2016, 26 patients with CAFs were enrolled in our study for attempted combined therapy using coils and Onyx. The mean age of patients was 64.0±9.5 years (range, 44-78 years). CAFs were large in 10 and medium in 16 patients. The mean number of coils used was 3.1±1.2 (range, two to six), and the average volume of Onyx was 0.4±0.1 ml (range, 0.2-0.6 ml). Immediate post-embolisation angiography demonstrated that complete occlusion was achieved in 23 patients (88.5%) and a small residual fistula was achieved in three patients (11.5%). Follow-up imaging (median, 11.5 months; range, nine to 20) revealed stable occlusion of CAF in 21 cases (80.8%), trivial recanalisation in four cases (15.4%), and large recanalisation in only one case (3.8%). Re-closure was performed in the patient with large recanalisation. During the follow-up period, no deaths, severe procedure-related complications, or new symptoms occurred. CONCLUSIONS In selected patients with CAF, transcatheter embolisation in combined therapy using coils and Onyx appears to be a valid option, providing a high success rate and low rate of recanalisation.
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Affiliation(s)
- Pan Li
- Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai, China
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Agarwal PP, Dennie C, Pena E, Nguyen E, LaBounty T, Yang B, Patel S. Anomalous Coronary Arteries That Need Intervention: Review of Pre- and Postoperative Imaging Appearances. Radiographics 2017; 37:740-757. [PMID: 28388272 DOI: 10.1148/rg.2017160124] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Coronary artery anomalies constitute a diverse group of abnormalities, ranging from anatomic variants to those having hemodynamic consequences. This review focuses on major anomalies that have clinical implications requiring treatment, including anomalous origin of the coronary artery from the opposite sinus with interarterial course specifically with an intramural course, coronary artery origin from the pulmonary artery, and coronary artery fistula. Comprehensive imaging evaluation is necessary to precisely delineate the anatomy as well as pathophysiologic aspects of the anomaly before determining treatment options for a specific patient. Coronary computed tomographic angiography provides elegant depiction of coronary arterial anatomy and the relationship of the vessel to the adjacent structures, with the ability to perform three-dimensional reconstructions. Magnetic resonance (MR) imaging is emerging as an alternative noninvasive imaging strategy, particularly in young individuals, due to the lack of ionizing radiation and avoidance of iodinated contrast agents. This review describes the roles and recent technical advancements in computed tomography and MR imaging pertinent to coronary artery imaging. Additionally, this article will familiarize readers with the cross-sectional imaging appearance of clinically relevant coronary anomalies, hemodynamic considerations, and complex decision making. The different management strategies used for these anomalies, such as coronary unroofing, reimplantation, bypass grafting, Takeuchi repair, and surgical and interventional closure of fistulas, as well as specific posttreatment complications, are also discussed. ©RSNA, 2017.
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Affiliation(s)
- Prachi P Agarwal
- From the Department of Radiology (P.P.A., S.P.), Department of Internal Medicine, Division of Cardiology (T.L.), and Department of Cardiac Surgery (B.Y.), University of Michigan Health System, 1500 E Medical Center Dr, Ann Arbor, MI 48109; Department of Radiology, University of Ottawa, Ottawa, Ont, Canada (C.D., E.P.); and Department of Radiology, University of Toronto, Toronto, Ont, Canada (E.N.)
| | - Carole Dennie
- From the Department of Radiology (P.P.A., S.P.), Department of Internal Medicine, Division of Cardiology (T.L.), and Department of Cardiac Surgery (B.Y.), University of Michigan Health System, 1500 E Medical Center Dr, Ann Arbor, MI 48109; Department of Radiology, University of Ottawa, Ottawa, Ont, Canada (C.D., E.P.); and Department of Radiology, University of Toronto, Toronto, Ont, Canada (E.N.)
| | - Elena Pena
- From the Department of Radiology (P.P.A., S.P.), Department of Internal Medicine, Division of Cardiology (T.L.), and Department of Cardiac Surgery (B.Y.), University of Michigan Health System, 1500 E Medical Center Dr, Ann Arbor, MI 48109; Department of Radiology, University of Ottawa, Ottawa, Ont, Canada (C.D., E.P.); and Department of Radiology, University of Toronto, Toronto, Ont, Canada (E.N.)
| | - Elsie Nguyen
- From the Department of Radiology (P.P.A., S.P.), Department of Internal Medicine, Division of Cardiology (T.L.), and Department of Cardiac Surgery (B.Y.), University of Michigan Health System, 1500 E Medical Center Dr, Ann Arbor, MI 48109; Department of Radiology, University of Ottawa, Ottawa, Ont, Canada (C.D., E.P.); and Department of Radiology, University of Toronto, Toronto, Ont, Canada (E.N.)
| | - Troy LaBounty
- From the Department of Radiology (P.P.A., S.P.), Department of Internal Medicine, Division of Cardiology (T.L.), and Department of Cardiac Surgery (B.Y.), University of Michigan Health System, 1500 E Medical Center Dr, Ann Arbor, MI 48109; Department of Radiology, University of Ottawa, Ottawa, Ont, Canada (C.D., E.P.); and Department of Radiology, University of Toronto, Toronto, Ont, Canada (E.N.)
| | - Bo Yang
- From the Department of Radiology (P.P.A., S.P.), Department of Internal Medicine, Division of Cardiology (T.L.), and Department of Cardiac Surgery (B.Y.), University of Michigan Health System, 1500 E Medical Center Dr, Ann Arbor, MI 48109; Department of Radiology, University of Ottawa, Ottawa, Ont, Canada (C.D., E.P.); and Department of Radiology, University of Toronto, Toronto, Ont, Canada (E.N.)
| | - Smita Patel
- From the Department of Radiology (P.P.A., S.P.), Department of Internal Medicine, Division of Cardiology (T.L.), and Department of Cardiac Surgery (B.Y.), University of Michigan Health System, 1500 E Medical Center Dr, Ann Arbor, MI 48109; Department of Radiology, University of Ottawa, Ottawa, Ont, Canada (C.D., E.P.); and Department of Radiology, University of Toronto, Toronto, Ont, Canada (E.N.)
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