Traumatic coronary arteriovenous fistula communicating the left main coronary artery to pulmonary artery, associated with pulmonary valvular insufficiency and endocarditis: case report

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

Coronary to pulmonary artery fistulae (CAF) are rare cardiac anomalies. The majority arise from the right coronary artery, with fistulae originating from the left anterior descending artery or from multiple arteries being less common. CAF are frequently asymptomatic and found incidentally on routine cardiac imaging. We present the case of a 61-year-old woman with multiple CAF who presented with progressive shortness of breath and chest pain and was ultimately treated successfully with trans-catheter coiling with marked improvement in symptoms. We also review the currently available literature regarding advances in diagnosis and treatment of CAF.

Acquired coronary cameral fistulas: are these collaterals losing their destination?

BACKGROUND

The majority of coronary cameral fistulas (CCFs) are congenital in origin. On the other hand, acquired coronary cameral fistulas, having various etiopathogenic origins, are increasingly recognized.

HYPOTHESIS

The aim of this study was to assess the possible involvement of coronary atherosclerosis in the pathogenesis of acquired coronary cameral fistulas.

METHODS

Between 1993 and 1996 coronary cameral fistulas were detected in seven adults patients with coronary atherosclerosis (n = 4) and following myocardial infarction (n = 3) with a mean age of 59.3 years (range 40-77). They were analyzed at our hospital.

RESULTS

Myocardial infarction (MI) was documented in six patients and was localized at the same territory of the fistula-related artery in three of them. All patients remained asymptomatic after the detection of the fistula. Five patients had associated cardiac disorders. Two patients were treated conservatively with medical therapy. Coronary artery bypass grafting (CABG) was performed in three patients. One patient died while awaiting CABG. Thirty-four adult cases with acquired CCFs were collected from the current literature. The right coronary artery was the origin of the fistula in 37% and they terminated into the right heart-side in 72% of cases. They remained asymptomatic in 62% of cases.

CONCLUSIONS

It could be concluded that acquired CCFs may complicate the course of severe atherosclerosis or myocardial infarction in certain adult patients. The symptomatology and treatment strategy is comparable in the congenital and acquired types. The distribution of involvement of the right or left coronary arteries is equally divided in both the acquired and congenital types. Further studies are needed to investigate the precipitating factors for the occurrence of and incidence of acquired CCFs in patients with severe atherosclerosis or post-MI subjects.

Traumatic coronary-pulmonary artery fistula, 23 years after a stab wound

We describe a 50-year-old man with onset of severe hemoptysis and anemia. Twenty-three years earlier, he had undergone a surgical procedure for a left thoracic wound as a result of a knife injury. Current diagnosis of aneurysm of the left ventricle and coronary-pulmonary artery fistula was made after coronary arteriography. The patient underwent resection of the aneurysm and repair of the fistula.

Traumatic coronary artery fistula management

Traumatic coronary artery-cameral fistulas (TCAF) are uncommon sequelae of trauma that require early surgical intervention to prevent complications. The etiology of traumatic coronary artery-cameral fistulas may be classified as accidental or iatrogenic and have distinctly different courses depending on the etiology. The two operations described for definitive surgical closure of a traumatic coronary-cameral fistula are external ligation/obliteration of the fistula (with or without bypass grafting to the coronary artery distal to the fistula) and direct repair of the fistula from within the recipient chamber. The technique of fistula closure from within the recipient chamber is associated with a reduced incidence of fistula recurrence. A case report and a collective literature review are presented.

False aneurysm of the left ventricle due to a penetrating chest wound

A 24-year-old white man had a knife chest wound, and four months after this event, manifested progressive dyspnea. A false aneurysm of the left ventricle was diagnosed by 2D echocardiogram. Surgical resection of the aneurysmal sac with closure of the orifice of the lateral wall of the left ventricle was performed successfully.