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Zergoune N, Benabdellah M, Hara L, Ech-Chenbouli A, Raissouni Z. Stable angina revealing a post-traumatic coronary cameral fistula: A case report. Radiol Case Rep 2024; 19:3522-3524. [PMID: 38881622 PMCID: PMC11179562 DOI: 10.1016/j.radcr.2024.05.037] [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: 05/04/2024] [Accepted: 05/13/2024] [Indexed: 06/18/2024] Open
Abstract
Coronary-cameral fistulas are abnormal connections between coronary arteries and any of the heart chambers, It may be acquired or congenital (whether isolated or along with congenital heart diseases); It is usually asymptomatic in younger patients; but with increasing age, symptoms begin to appear, and the incidence of complication rises. Coronary angiography is the gold standard in diagnosis but echography and cardiac magnetic resonance imaging may be also useful. It can be treated medically with β-blockers or calcium channel blockers, but large fistulas with hemodynamic significant shunts should be closed by transcatheter or surgical means. We present a 57-year-old patient with a history of chest trauma, that present fistulas connecting the 3 coronary arteries to the left ventricle chamber complicated by myocardial ischemia causing stable angina.
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Affiliation(s)
- Nabil Zergoune
- University Hospital Mohamed VI, Cardiology Department, Abdelmalek Essadi University, Tangier, Morocco
| | - Malak Benabdellah
- University Hospital Mohamed VI, Cardiology Department, Abdelmalek Essadi University, Tangier, Morocco
| | - Loubna Hara
- University Hospital Mohamed VI, Cardiology Department, Abdelmalek Essadi University, Tangier, Morocco
| | - Amine Ech-Chenbouli
- University Hospital Mohamed VI, Cardiology Department, Abdelmalek Essadi University, Tangier, Morocco
| | - Zainab Raissouni
- University Hospital Mohamed VI, Cardiology Department, Abdelmalek Essadi University, Tangier, Morocco
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2
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Guo L, Wen J, Qin L, Yan Z. Multimodal imaging diagnosis of giant right coronary aneurysm: A rare case report. Asian J Surg 2024:S1015-9584(24)01388-5. [PMID: 38987143 DOI: 10.1016/j.asjsur.2024.07.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 07/04/2024] [Indexed: 07/12/2024] Open
Affiliation(s)
- Liping Guo
- Department of Ultrasound, Liuzhou Worker's Hospital, Liuzhou, 545005, Guangxi, China.
| | - Jia Wen
- Department of Ultrasound, Liuzhou Worker's Hospital, Liuzhou, 545005, Guangxi, China
| | - Lang Qin
- Department of Ultrasound, Liuzhou Worker's Hospital, Liuzhou, 545005, Guangxi, China
| | - Zhong Yan
- Department of Ultrasound, Liuzhou Worker's Hospital, Liuzhou, 545005, Guangxi, China
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3
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Ozenbas C, Sukun A. Giant Coronary-Pulmonary Artery Fistula Incidentally Detected in a Patient Presenting With Acute Inferior Myocardial Infarction. Cureus 2024; 16:e58627. [PMID: 38770477 PMCID: PMC11103546 DOI: 10.7759/cureus.58627] [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: 04/20/2024] [Indexed: 05/22/2024] Open
Abstract
Coronary artery fistulas are abnormal connections between the coronary arteries and the heart or other surrounding vascular structures. Although they are usually congenital, they can also occur iatrogenically or due to trauma. They are usually asymptomatic, but they can cause serious and even fatal complications. These complications include myocardial infarction, embolism, thrombosis, arrhythmia, and rupture. In a 54-year-old woman admitted to the emergency department with an acute inferior myocardial infarction, a giant coronary-pulmonary artery fistula was detected on angiography. The fistula could not be closed percutaneously, and computed tomography angiography (CTA) revealed extensive aneurysms and diffuse calcifications. Large fistulas should be closed due to the risk of rupture. Small fistulas should be detected by CTA, and radiologists should be familiar with the imaging features.
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Affiliation(s)
- Cemre Ozenbas
- Radiology, Tınaztepe University Private Buca Hospital, Izmir, TUR
| | - Abdullah Sukun
- Radiology, Başkent University Alanya Application and Research Center, Antalya, TUR
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4
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Yan W, He Z, Luo Y, Huang W, Zhu B, Zhong Y, Wang X. Prevalence and characteristics of coronary artery fistulas among 20 259 patients undergoing invasive coronary angiography. Coron Artery Dis 2024; 35:135-142. [PMID: 38206811 DOI: 10.1097/mca.0000000000001327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
BACKGROUND Coronary artery fistula (CAF) is a rare coronary anomaly. This study aimed to investigate the prevalence, clinical features, and imaging characteristics of CAF among patients undergoing coronary angiography (CAG). METHOD This was a retrospective study including 20 259 consecutive patients (12 458 were male) who underwent CAG at our institution from September 2018 to March 2023. Electronic angiography records were reviewed, and a total of 86 (0.42%) CAF patients were enrolled and analyzed. RESULT Of the 86 CAF patients, 42 (49%) were male. Thus, the prevalence of CAF for males and females was 0.34% and 0.56%, respectively. Arrhythmia, left ventricular (LV) hypertrophy, LV dilation, and LV systolic dysfunction were observed in 38, 25, 10 and 5 cases, respectively. Among the 86 CAF patients, a total of 117 CAFs were detected. 61 (71%) patients had a single CAF, and the remaining 25 (29%) patients had multiple CAFs. Of the 117 CAFs, the most common origins and terminations were the left anterior descending artery (n = 50) and the pulmonary artery (n = 73), respectively. The CAF diameters were greatly varied, ranging from unmeasurable to 7.8 mm, and 22 (18%) CAFs were larger than 3 mm. CONCLUSION In the present study, the prevalence of CAF was 0.42% with a female predilection. Arrhythmia, LV remodeling and dysfunction were common. Seventy-one percent of patients had a single CAF. The left anterior descending artery and the pulmonary artery were the most common origin and termination of CAFs, respectively. Most CAFs were small, and 18% of CAFs were larger than 3 mm.
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Affiliation(s)
- Wei Yan
- Department of Cardiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
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5
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Ørbæk Andersen M, Smerup MH, Munk K, Mortensen UM, Nørgaard BL, Helvind M, Andersen HØ, Linde JJ. Computed tomographic-based three-dimensional printing of giant coronary artery fistulas to guide surgical strategy: a case series. Eur Heart J Case Rep 2024; 8:ytad413. [PMID: 38374985 PMCID: PMC10875921 DOI: 10.1093/ehjcr/ytad413] [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: 12/19/2022] [Revised: 08/07/2023] [Accepted: 08/16/2023] [Indexed: 02/21/2024]
Abstract
Background Coronary artery fistulas (CAFs) are abnormal communications between the coronary arteries and the heart chambers, arteries, or veins, potentially leading to significant shunting, myocardial ischaemia and heart failure. Computed tomographic (CT) angiography or conventional invasive angiography is the reference standard for the diagnosis of coronary fistulas. The fistula anatomy can become very complex, which makes surgical or interventional planning challenging. Case summary We report two cases of hugely dilated and tortuous coronary circumflex artery fistulas draining into the coronary sinus. Both patients were followed up for more than 10 years because of very complex coronary fistula anatomy and mild symptoms. From two-dimensional (2D) sliced CT images alone it, was uncertain whether surgery was feasible. However, since both patients had symptom progression (Patient 1 developed heart failure, and Patient 2 had recurrent pericardial effusions), three-dimensional (3D) heart models were printed for better understanding of the complex fistula anatomy and improved surgical planning. Both patients had successful surgery and symptomatic relief at follow-up. Discussion The delay in surgery, until clinical deterioration, may partly be a consequence of a general reluctance in performing complex surgery in patients with CAFs. As of now, CT-based 3D printing has primarily been used in isolated cases. However, 3D printing is evolving rapidly and supplementing 2D sliced CT images with a physical 3D heart model may improve the anatomical understanding and pre-surgical planning that could lead to better surgical outcome.
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Affiliation(s)
- Mads Ørbæk Andersen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Morten H Smerup
- Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Kim Munk
- Department of Cardiology, Aarhus University Hospital, 8200 Århus, Denmark
| | | | | | - Morten Helvind
- Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Henrik Ørbæk Andersen
- Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jesper James Linde
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
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6
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Namura S, Konishi H, Nishio R, Yamamoto H. Minimally invasive coil embolization for significant left-to-right shunts due to giant coronary-to-pulmonary artery fistulas: a case report. Eur Heart J Case Rep 2024; 8:ytae006. [PMID: 38249116 PMCID: PMC10799663 DOI: 10.1093/ehjcr/ytae006] [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: 06/25/2023] [Revised: 12/21/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024]
Abstract
Background Coronary-to-pulmonary artery fistula (CPF) is a rare disease, and its optimal treatment strategy remains controversial. Herein, we report a rare case of minimally invasive coil embolization of giant CPFs. Case summary A 78-year-old man with a history of persistent atrial fibrillation and lumbar canal stenosis presented to our hospital with breathlessness. Cardiac computed tomography revealed giant CPFs inducing a significant left-to-right shunt (Qp/Qs 1/2.1) with a coronary artery aneurysm smaller than the size indicated for surgical treatment. To reduce the left-to-right shunt flow, coil embolization procedures for the fistulas were performed twice. Initially, the fistula arising from the right coronary artery was embolized using three Target® XXL (6 × 40 mm, 5 × 20 mm) and two Target® XL SOFT (4 × 12 mm) coils (Stryker Inc., Tokyo, Japan). One month later, the fistulas arising separately from the left coronary artery were embolized. After the procedures, the major shunt flow disappeared angiographically, and Qp/Qs significantly decreased to 1/1.2. Additionally, the fractional flow reserve of the left coronary artery increased from 0.79 to 0.93, and cardiopulmonary exercise testing showed an improvement in his exercise tolerance. Discussion In similar cases, a surgical procedure with ligation of the CPFs combined with resection of a small aneurysm and coronary artery bypass grafting would normally have been considered the best approach. However, endovascular treatment targeting only the fistulas was a superior strategy considering the patient's age. The coil embolization technique effectively controlled the shunt flow of the CPFs. This technique is considerably less invasive than surgical therapy.
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Affiliation(s)
- Sato Namura
- Department of Cardiology, Yodogawa Christian Hospital, 1-7-50, Kunijima, Higashiyodogawa-ku, Osaka 533-0024, Japan
| | - Hiroki Konishi
- Department of Cardiology, Yodogawa Christian Hospital, 1-7-50, Kunijima, Higashiyodogawa-ku, Osaka 533-0024, Japan
| | - Ryo Nishio
- Department of Cardiology, Yodogawa Christian Hospital, 1-7-50, Kunijima, Higashiyodogawa-ku, Osaka 533-0024, Japan
| | - Hiroshi Yamamoto
- Department of Diagnostic Radiology, Sumitomo Hospital Interventional Radiology Center, 5-3-20, Nakanoshima, Kita-ku, Osaka 530-0005, Japan
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7
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Chakraborty S, Luthra K, Shah J, Baghal M, Ghumman GM, Salman F, Singh H, Ali SS. Coil Embolization of a Left Anterior Descending Coronary Artery-Pulmonary Artery Fistula: A Case Report. Cureus 2023; 15:e50521. [PMID: 38226085 PMCID: PMC10788882 DOI: 10.7759/cureus.50521] [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: 12/13/2023] [Indexed: 01/17/2024] Open
Abstract
Coronary artery fistulas may be defined as abnormal connections between a coronary artery and either a heart chamber or the pulmonary artery. Although usually asymptomatic, they can become enlarged and rupture in rare instances, requiring prompt intervention. We present a case of a 66-year-old male patient with a left anterior descending-pulmonary artery fistula managed with coil embolization.
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Affiliation(s)
| | - Kritika Luthra
- Internal Medicine, Mercy Health - St. Vincent Medical Center, Toledo, USA
| | - Jay Shah
- Cardiovascular Disease, Mercy Health - St. Vincent Medical Center, Toledo, USA
| | - Moaaz Baghal
- Cardiology, Mercy Health - St. Vincent Medical Center, Toledo, USA
| | | | - Fnu Salman
- Internal Medicine, Mercy Health - St. Vincent Medical Center, Toledo, USA
| | - Hemindermeet Singh
- Interventional Cardiology, Mercy Health - St. Vincent Medical Center, Toledo, USA
| | - Syed S Ali
- Interventional Cardiology, Mercy Health - St. Vincent Medical Center, Toledo, USA
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8
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Wang Y, Zhang Y, Wang F, Xue Y. Case report: Right coronary artery to left ventricular fistula complicated with coronary artery dilation presenting as persistent cardiogenic ischemic chest pain. Front Cardiovasc Med 2023; 10:1238034. [PMID: 37771664 PMCID: PMC10526361 DOI: 10.3389/fcvm.2023.1238034] [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: 06/10/2023] [Accepted: 09/01/2023] [Indexed: 09/30/2023] Open
Abstract
We reported a patient with a fistula of the right coronary artery to the left ventricle, accompanied by dilation of the right coronary artery and persistent chest pain. This patient underwent surgical fistula closure surgery, but the fistula recurred. Persistent chest pain reappeared after encountering COVID-19 infection. We analyzed the mechanism of persistent myocardial ischemic chest pain caused by coronary artery fistula in this patient, the impact of surgery on the patient's disease, the possible mechanism of COVID-19 causing persistent ischemic chest pain in this patient, and the possible mechanism of metoprolol in alleviating myocardial ischemic chest pain in this patient.
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Affiliation(s)
- Yuehai Wang
- Cardiology Department, Liaocheng People’s Hospital of Shandong University and Liaocheng Hospital Affiliated to Shandong First Medical University, Liaocheng, China
- Laboratory Animal Center, Liaocheng People’s Hospital of Shandong University and Liaocheng Hospital Affiliated to Shandong First Medical University, Liaocheng, China
| | - Yuqiang Zhang
- Cardiology Department, Liaocheng People’s Hospital of Shandong University and Liaocheng Hospital Affiliated to Shandong First Medical University, Liaocheng, China
- Laboratory Animal Center, Liaocheng People’s Hospital of Shandong University and Liaocheng Hospital Affiliated to Shandong First Medical University, Liaocheng, China
| | - Fei Wang
- Department of Cardiology, Shandong Corps Hospital of Chinese People’s Armed Police Forces, Jinan, China
| | - Yuzeng Xue
- Cardiology Department, Liaocheng People’s Hospital of Shandong University and Liaocheng Hospital Affiliated to Shandong First Medical University, Liaocheng, China
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9
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Liu Q, Jiang J. Cinematic rendering of the coronary-pulmonary arterial fistula. Radiol Case Rep 2023; 18:3140-3144. [PMID: 37388534 PMCID: PMC10302156 DOI: 10.1016/j.radcr.2023.06.033] [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: 04/26/2023] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 07/01/2023] Open
Abstract
Coronary-pulmonary arterial fistula is a rare coronary artery abnormality disease, which refers to a coronary fistula that terminates at the pulmonary artery. Coronary-pulmonary fistulas are much less common in children than in adults, and the small fistulas are easily missed. We report the case of a 9-year-old girl who presented with coronary-pulmonary arterial fistula. She underwent multimodal imaging, including chest X-ray, echocardiography, computed tomography with 3-dimensional cinematic rendering. We found that the cinematic rendering images clearly showed the small-caliber fistulous connections. The combination of CT and echocardiography can effectively help doctors understand the anatomical details and hemodynamic information.
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10
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Biyani G, Pota A, Misri A. An unusual case of coronary artery fistula successfully treated by transcatheter approach. Cardiol Young 2023; 33:1769-1771. [PMID: 37038836 DOI: 10.1017/s1047951123000367] [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] [Indexed: 04/12/2023]
Abstract
Coronary artery fistulas are rare, but one of the most common forms of congenital coronary abnormalities. These patients are often diagnosed incidentally undergoing coronary angiography, but with the advent of novel cardiac imaging tools, there is an increasing rate of detection as well as transcatheter management of these fistulas. Our case is unusual in a way that it involved a combination of two separate coronary artery fistulas arising from both the coronary systems draining into the same site.
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Affiliation(s)
- Garima Biyani
- Department of Pediatric Cardiology, Medanta The Medicity, Gurugram, Haryana 122001, India
| | - Abhay Pota
- Department of Pediatric Cardiology, UN Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat380004, India
| | - Amit Misri
- Department of Pediatric Cardiology, Medanta The Medicity, Gurugram, Haryana 122001, India
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11
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Achim A, Johnson NP, Liblik K, Burckhardt A, Krivoshei L, Leibundgut G. Coronary steal: how many thieves are out there? Eur Heart J 2023; 44:2805-2814. [PMID: 37264699 DOI: 10.1093/eurheartj/ehad327] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/17/2023] [Accepted: 05/12/2023] [Indexed: 06/03/2023] Open
Abstract
The colorful term "coronary steal" arose in 1967 to parallel "subclavian steal" coined in an anonymous 1961 editorial. In both instances, the word "steal" described flow reversal in the setting of an interconnected but abnormal vascular network-in one case a left subclavian stenosis proximal to the origin of the vertebral artery and in the other case a coronary fistula. Over time, the term has morphed to include a larger set of pathophysiology without explicit flow reversal but rather with a decrease in stress flow due to other mechanisms. This review aims to shed light on this phenomenon from a clinical and a pathophysiological perspective, detailing the anatomical and physiological conditions that allow so-called steal to appear and offering treatment options for six distinct scenarios.
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Affiliation(s)
- Alexandru Achim
- Department of Cardiology, Medizinische Universitätsklinik, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
- Cardiology Department, Heart Institute "Niculae Stancioiu", University of Medicine and Pharmacy "Iuliu Hatieganu", Motilor 19-21, 400001, Cluj-Napoca, Romania
| | - Nils P Johnson
- Division of Cardiology, Department of Medicine, Weatherhead PET Center, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, TX, USA
| | - Kiera Liblik
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Amélie Burckhardt
- Department of Cardiology, Medizinische Universitätsklinik, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Lian Krivoshei
- Department of Cardiology, Medizinische Universitätsklinik, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Gregor Leibundgut
- Department of Cardiology, Medizinische Universitätsklinik, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
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12
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Alam MM, Tasha T, Ghosh AS, Nasrin F. Coronary Artery Anomalies: A Short Case Series and Current Review. Cureus 2023; 15:e38732. [PMID: 37292534 PMCID: PMC10247158 DOI: 10.7759/cureus.38732] [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: 05/08/2023] [Indexed: 06/10/2023] Open
Abstract
Coronary artery anomalies (CAAs) are rare congenital cardiovascular defects that can present in various ways depending on the origin, course, and termination of the abnormal coronary artery fistula. It is sometimes detected incidentally during procedures such as coronary angiography or autopsies. While adults with this condition are often asymptomatic, some may experience angina, congestive heart failure, myocardial infarction, cardiomyopathy, ventricular aneurysms, or sudden cardiac death (SCD). In fact, it is the second leading cause of SCD among young athletes and requires more studies to handle such patients efficiently. To illustrate the many possible manifestations of this unusual diagnosis, we present a series of five cases. We have also reviewed the different varieties of this rare congenital anomaly and discussed the latest diagnostic tests and treatment plans.
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Affiliation(s)
- Md Mashiul Alam
- Internal Medicine, Bridgeport Hospital/Yale University, Bridgeport, USA
| | - Tasniem Tasha
- Internal Medicine, Fralin Biomedical Research Institute, Virginia Tech, Blacksburg, USA
| | - Ammy S Ghosh
- Hematology-Oncology, University of Michigan, Ann Arbor, USA
| | - Farjana Nasrin
- Oncology, Howard University Hospital, Washington, DC, USA
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13
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Ghumman GM, Khan A, Shafqat M, Shah J, Singh H. A Coronary Cameral Fistula Associated With Incessant Ventricular Arrhythmias. Cureus 2023; 15:e35847. [PMID: 37033551 PMCID: PMC10076682 DOI: 10.7759/cureus.35847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2023] [Indexed: 03/09/2023] Open
Abstract
Coronary cameral fistula (CCF) is a rare congenital abnormality of abnormal communication between coronary arteries and cardiac chambers. Most patients are asymptomatic, while symptomatic patients are usually present in childhood. Adult patients can present with angina, heart failure, or arrhythmias. We report a rare case of CCF with associated recurrent torsade de pointes (TdP) in the absence of ischemic heart disease and electrolyte abnormalities.
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14
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Zhao K, Zhang L, Wang L, Zeng J, Zhang Y, Xie X. Benign incidental cardiac findings in chest and cardiac CT imaging. Br J Radiol 2023; 96:20211302. [PMID: 35969186 PMCID: PMC9975525 DOI: 10.1259/bjr.20211302] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 07/25/2022] [Accepted: 08/06/2022] [Indexed: 02/01/2023] Open
Abstract
With the continuous expansion of the disease scope of chest CT and cardiac CT, the number of these CT examinations has increased rapidly. In addition to their common indications, many incidental cardiac findings can be observed when carefully evaluating the coronary arteries, valves, pericardium, ventricles, and large vessels. These findings may have clinical significance or risk of complications, but they are sometimes overlooked or may not be described in the final reports. Although most of the incidental findings are benign, timely detection and treatment can improve the management of chronic diseases or reduce the possibility of severe complications. In this review, we summarized the imaging findings, incidence rate, and clinical relevance of some benign cardiac findings such as coronary artery calcification, aortic and mitral valve calcification, aortic calcification, cardiac thrombus, myocardial bridge, aortic dilation, cardiac myxoma, pericardial cyst, and coronary artery fistula. Reporting incidental cardiac findings will help reduce the risk of severe complications or disease deterioration and contribute to the recovery of patients.
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Affiliation(s)
- Keke Zhao
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Haining Rd.100, Shanghai, China
| | - Lu Zhang
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Haining Rd.100, Shanghai, China
| | - Lingyun Wang
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Haining Rd.100, Shanghai, China
| | - Jinghui Zeng
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Haining Rd.100, Shanghai, China
| | - Yaping Zhang
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Haining Rd.100, Shanghai, China
| | - Xueqian Xie
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Haining Rd.100, Shanghai, China
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15
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Lee YR, Choi ES. Surgical Management of a Large Right Coronary Artery to Left Ventricle Fistula in a Neonate: A Case Report. J Chest Surg 2023; 56:49-52. [PMID: 36097820 PMCID: PMC9845858 DOI: 10.5090/jcs.22.034] [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: 05/02/2022] [Revised: 06/22/2022] [Accepted: 07/07/2022] [Indexed: 01/29/2023] Open
Abstract
A fistula from the right coronary artery draining into the left ventricle is a rare form of coronary artery fistula. Here, we describe the case of a symptomatic neonate with a large fistula of this type. The neonate was successfully treated with surgical closure of the fistula.
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Affiliation(s)
- Yu Ri Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Seok Choi
- Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea,Corresponding author Eun Seok Choi Tel 82-2-3010-3587 Fax 82-2-3010-6966 E-mailORCIDhttps://orcid.org/0000-0002-0618-4686
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16
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Trang PTT, Cuong TC, Tha TTT, Dil MH, Cuong NM, Tin DN, Tran NT, Thang LM, Chinh ND, Hoa T, Dung BT, Hieu TB, Duc NM. A Complicated Case Report of Coronary Artery Fistula. Med Arch 2023; 77:489-492. [PMID: 38313104 PMCID: PMC10834043 DOI: 10.5455/medarh.2023.77.489-492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/25/2023] [Indexed: 02/06/2024] Open
Abstract
Background Coronary artery fistulas (CAFs), also, known as coronary arteriovenous malformation, are aberrant connections between coronary arteries and other structures, such as other artery branches or heart chambers. CAFs are infrequent and asymptomatic in young patients, but symptoms and complications become more frequent with age. CAFs can affect hemodynamic parameters and lead to complications, such as myocardial ischemia, heart failure, arrhythmia, and infective endocarditis. Objective The aim of this article was to present a typical CAF case with severe symptoms who underwent successful embolization to resolve their symptoms. Case presentation A 50-year-old Vietnamese male visited our cardiac outpatient clinic (S.I.S General Hospital, Can Tho, Vietnam) because of exertional dyspnea and chest pain. Signs of congestive heart failure and abnormal murmur were not presented on chest auscultation. Diagnostic digital subtraction angiography was performed to determine the detailed angioarchitecture of the CAF, revealing a fistulous connection between the left anterior descending artery (LAD) and the LV chamber through an aneurysm. In addition, the RCA measured 7 mm in diameter with a fistula (16 × 9 mm) draining into an aneurysm and then terminating into the LV chamber. The patient had an RCA aneurysm with a fistula into the LV. It was treated successfully by closing the fistula with a vascular plug. Access to the fistula was complex and difficult because of complications due to the CAF. After the procedure, the patient had no chest pain or shortness of breath and was discharged after three days. After six months, he was taking dual antiplatelet therapy and antihypertensive medications and felt better. We performed contrast computed tomography (CT) to examine the fistula after a year, which showed the successful closure of the fistula without any relevant alteration in the coronary artery. Conclusion CAF closure is indicated if patients have symptoms or secondary complications, and percutaneous closure is a safe and effective method to manage CAF. A CAF is rare and does not have specific symptoms, making it difficult to diagnose. Most patients are asymptomatic and have serious recent complications. Currently, the percutaneous transcatheter method is popular because it is noninvasive and successful in most patients.
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Affiliation(s)
- Pham-Thi Thao Trang
- Department of Internal medicine, Can Tho S.I.S General Hospital, Can Tho, Vietnam
| | - Tran Chi Cuong
- Digital Subtraction Angiography Unit, Can Tho S.I.S General Hospital, Can Tho, Vietnam
| | - Tran-Thi Thanh Tha
- Department of Internal medicine, Can Tho S.I.S General Hospital, Can Tho, Vietnam
| | - Mai Hoang Dil
- Digital Subtraction Angiography Unit, Can Tho S.I.S General Hospital, Can Tho, Vietnam
| | - Nguyen Manh Cuong
- Digital Subtraction Angiography Unit, Can Tho S.I.S General Hospital, Can Tho, Vietnam
| | - Do Nguyen Tin
- Department of Pediatrics, University of Medicine and Pharmacy, Ho Chi Minh city, Vietnam
| | - Nguyen Tran Tran
- Department of Internal medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Le Minh Thang
- Digital Subtraction Angiography Unit, Can Tho S.I.S General Hospital, Can Tho, Vietnam
| | - Nguyen Duc Chinh
- Department of Cardiology, Can Tho S.I.S General Hospital, Can Tho, Vietnam
| | - Tran Hoa
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Bui The Dung
- Department of Cardiology, University Medical Center HCMC, Ho Chi Minh City, Vietnam
| | - Tran Ba Hieu
- Coronary Care Unit, Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
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17
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Bou Chaaya RG, Sammour Y, Thakkar S, Jaradat Z, Gill WJ, Batal O. Dual Coronary-Pulmonary Artery Fistula in a Patient with Severe Bicuspid Aortic Valve Stenosis. Methodist Debakey Cardiovasc J 2023; 19:32-37. [PMID: 37064497 PMCID: PMC10103714 DOI: 10.14797/mdcvj.1187] [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: 11/15/2022] [Accepted: 01/11/2023] [Indexed: 04/18/2023] Open
Abstract
A 62-year-old male presented to the emergency department with acute viral bronchitis and worsening of his chronic dyspnea on exertion. Incidentally, a murmur was detected on physical examination. Extensive work-up, including coronary computed tomography angiography, revealed a rare combination and potential association between severe bicuspid aortic valve stenosis and coronary-pulmonary artery fistulas.
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Affiliation(s)
| | - Yasser Sammour
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, US
| | | | - Ziad Jaradat
- Indiana University School of Medicine, Indianapolis, Indiana, US
| | - William J. Gill
- Indiana University School of Medicine, Indianapolis, Indiana, US
| | - Omar Batal
- Indiana University School of Medicine, Indianapolis, Indiana, US
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18
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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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19
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Izadpanah P, Hooshanginezhad Z, Shojaie M. Monster left circumflex artery fistula closure by vascular plug in a patient with post‐
COVID
‐19 myocardial infarction. Clin Case Rep 2022; 10:e6579. [PMID: 36408082 PMCID: PMC9666905 DOI: 10.1002/ccr3.6579] [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: 03/25/2022] [Revised: 08/22/2022] [Accepted: 10/25/2022] [Indexed: 11/17/2022] Open
Abstract
Herein, we report a man with a huge coronary fistula connecting the left circumflex coronary artery to the right ventricle. During the follow‐up, the patient developed progressive symptoms of heart failure nonresponsive to medical treatment. Therefore, an endovascular closure with a vascular plug was successfully done for him. Transcatheter vascular plug occlusion can be considered as an alternative for closure of symptomatic high‐flow large coronary artery fistulas in patients with a high risk of surgery and chance of coil dislocation, embolization, or unavailability of proper coils.
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Affiliation(s)
- Peyman Izadpanah
- Department of CardiologyShiraz University of Medical SciencesShirazIran
| | | | - Mohammad Shojaie
- Cardiology DepartmentJahrom University of Medical SciencesJahromFarsIran
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20
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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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21
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Coronary artery fistulas: A Portuguese single-center experience. Rev Port Cardiol 2022; 41:851-852. [DOI: 10.1016/j.repc.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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22
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Comparison of pre- and postnatally diagnosed coronary artery fistulae: Echocardiographic features and clinical outcomes. J Am Soc Echocardiogr 2022; 35:1322-1335. [DOI: 10.1016/j.echo.2022.07.015] [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: 11/08/2021] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 11/17/2022]
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23
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Torres S, Vasconcelos M, Tavares Silva M, Moreira J, Silva JC, Macedo F. Coronary artery fistulas: A 12-year single-center experience. Rev Port Cardiol 2022; 41:843-850. [DOI: 10.1016/j.repc.2021.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/05/2021] [Accepted: 06/21/2021] [Indexed: 10/15/2022] Open
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24
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Manongi N, Kim S. A Case of Takotsubo Cardiomyopathy in a Patient With Coronary Artery Fistula. Cureus 2022; 14:e26896. [PMID: 35865182 PMCID: PMC9293266 DOI: 10.7759/cureus.26896] [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] [Accepted: 07/15/2022] [Indexed: 11/05/2022] Open
Abstract
Takotsubo cardiomyopathy (TTC) is also known as stress-induced cardiomyopathy and mimics acute coronary syndrome in the setting of non-obstructive coronary artery disease. It is associated with reversible left ventricular apical, mid, and/or basal wall motion abnormalities. A coronary artery fistula (CAF) is a connection between one or more of the coronary arteries and the cardiac chamber or great vessel. We present a case of an elderly woman who presented with chest pain and was found to have non-obstructive coronary artery disease with wall motion abnormality pattern consistent with TTC and multiple CAF involving the left circumflex coronary artery and pulmonary artery. This case highlights a rare association between two uncommon entities.
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25
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Rodríguez Urteaga ZI, Murillo Pérez LE, Mendoza Paulini A, Talledo Paredes LS. [Prevalence of coronary anomalies detected by computed tomography at the Instituto Nacional Cardiovascular- INCOR]. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2022; 3:153-161. [PMID: 37284572 PMCID: PMC10241344 DOI: 10.47487/apcyccv.v3i2.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/26/2022] [Indexed: 06/08/2023]
Abstract
Objective : To determine the prevalence of coronary anomalies (CA) in patients evaluated by 64-detector computed tomography (CT) at the Instituto Nacional Cardiovascular in Peru between 2016 and 2020. Materials and methods Retrospective observational study, coronary artery CT scans of 1486 patients were performed on a 64-detector row CT scanner and reviewed in search for coronary anomalies. Results The prevalence of CA detected by CT was 4.71% (70 cases) of which 64.3% were male. Abnormalities of origin were the most frequent, of which the origin of a coronary artery from the opposite coronary sinus was the most common (48.6%), with the right coronary being the main anomalous artery (31%), and the main path was interarterial (31%). Anomalous origin of the left main coronary from the pulmonary artery was found in 5 patients. Among the anomalies of the intrinsic coronary arterial anatomy the most frequent was the double left anterior descending artery (10%). Coronary fistulas accounted for 11.4% of cases. Conclusions The prevalence of CA detected by 64-detector CT in a Peruvian institute was 4.71%. The most frequent coronary anomaly was the origin of the right coronary artery from the left coronary sinus with interarterial trajectory.
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Affiliation(s)
- Zoila I Rodríguez Urteaga
- . Cardiología no invasiva. Instituto Nacional Cardiovascular "Carlos Alberto Peschiera Carrillo" - INCOR. Lima, Perú. Cardiología no invasiva Instituto Nacional Cardiovascular "Carlos Alberto Peschiera Carrillo" - INCOR Lima Perú
| | - Luis E Murillo Pérez
- . Cardiología no invasiva. Instituto Nacional Cardiovascular "Carlos Alberto Peschiera Carrillo" - INCOR. Lima, Perú. Cardiología no invasiva Instituto Nacional Cardiovascular "Carlos Alberto Peschiera Carrillo" - INCOR Lima Perú
| | - Aurelio Mendoza Paulini
- . Cardiología no invasiva. Instituto Nacional Cardiovascular "Carlos Alberto Peschiera Carrillo" - INCOR. Lima, Perú. Cardiología no invasiva Instituto Nacional Cardiovascular "Carlos Alberto Peschiera Carrillo" - INCOR Lima Perú
| | - Luisa S Talledo Paredes
- . Cardiología no invasiva. Instituto Nacional Cardiovascular "Carlos Alberto Peschiera Carrillo" - INCOR. Lima, Perú. Cardiología no invasiva Instituto Nacional Cardiovascular "Carlos Alberto Peschiera Carrillo" - INCOR Lima Perú
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26
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Chen Y, Lin L, Deng Q, Li N, Wang Z, Liu J, Sun H. Coronary artery-bronchial artery fistula imaging characteristics and its correlation with pulmonary disease severity. Heart Vessels 2022; 37:2101-2106. [PMID: 35729428 DOI: 10.1007/s00380-022-02106-y] [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] [Received: 12/20/2021] [Accepted: 05/19/2022] [Indexed: 11/28/2022]
Abstract
Hemoptysis is a common clinical emergency, bronchial arterial embolization is considered to be an effective treatment. The presence of coronary artery-bronchial artery fistula (CBF) may lead to recurrence of hemoptysis after treatment. It is necessary to investigate the imaging characteristics of a CBF and its correlation with the severity of pulmonary disease. With the development of multi-detector computed tomography, our study used the 320-slice CT bronchial artery angiography technology to observe and visualize blood vessels. The image and clinical data of 2015 hemoptysis patients with 320-slice CT bronchial artery angiography were retrospectively reviewed from January 2015 to December 2019. The axial and three-dimensional CT images were analyzed. The incidence, anatomical characteristics of CBF and pulmonary disease severity score were evaluated. A total of 12 CBF vessels were detected in 11 patients. We found that the incidence of CBF in this group was 0.55% (11/2015). Mean CBF diameter was 1.9 mm (1.2-2.5 mm). The course of CBF usually was relatively fixed. The proportions of CBF originated from the left circumflex artery, right coronary artery, and left anterior descending artery were 75%, 16.7% and 8.3%, respectively. Preliminarily analysis of the correlation between the trend of CBF and the pulmonary diseases severity score showed that CBF was more likely to communicate with a bronchial artery on the side with a higher severity score. CBF may occur in patients with chronic pulmonary disease and hemoptysis, and its origin, course and trend are characteristic. Detailed and comprehensive computed tomography angiography image analysis is helpful to improve the clinical treatment of hemoptysis with CBF.
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Affiliation(s)
- Yonghua Chen
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Liaoyi Lin
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Qingshan Deng
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Na Li
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Zhenzhang Wang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Jinjin Liu
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China.
| | - Houzhang Sun
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China.
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27
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Taramasso M, Ahmad SS. A Road Less Traveled. JACC Case Rep 2022; 4:395-396. [PMID: 35693906 PMCID: PMC9175195 DOI: 10.1016/j.jaccas.2021.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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28
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Tzimas G, Gulsin GS, Takagi H, Mileva N, Sonck J, Muller O, Leipsic JA, Collet C. Coronary CT Angiography to Guide Percutaneous Coronary Intervention. Radiol Cardiothorac Imaging 2022; 4:e210171. [PMID: 35782760 PMCID: PMC8893214 DOI: 10.1148/ryct.210171] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 11/08/2021] [Accepted: 11/22/2021] [Indexed: 05/03/2023]
Abstract
Coronary CT angiography (CCTA) has emerged as a powerful noninvasive tool for characterizing the presence, extent, and severity of coronary artery disease (CAD) in patients with stable angina. Recent technological advancements in CT scanner hardware and software have augmented the rich information that can be derived from a single CCTA study. Beyond merely identifying the presence of CAD and assessing stenosis severity, CCTA now allows for the identification and characterization of plaques, lesion length, and fluoroscopic angle optimization, as well as enables the assessment of the physiologic extent of stenosis through CT-derived fractional flow reserve, and may even allow for the prediction of the response to revascularization. These and other features make CCTA capable of not only guiding invasive coronary angiography referral, but also give it the unique ability to help plan coronary intervention. This review summarizes current and future applications of CCTA in procedural planning for percutaneous coronary intervention, provides rationale for wider integration of CCTA in the workflow of the interventional cardiologist, and details how CCTA may help improve patient care and clinical outcomes. Keywords: CT Angiography © RSNA, 2022.
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Affiliation(s)
- Georgios Tzimas
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z4 (G.T., G.S.G., H.T.,
J.A.L.); Department of Heart Vessels, Cardiology Service, Lausanne University
Hospital and University of Lausanne, Lausanne, Switzerland (G.T., O.M.);
University of Leicester and the Leicester NIHR Biomedical Research Centre,
Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, England
(G.S.G.); Department of Diagnostic Radiology, Tohoku University Hospital,
Sendai, Japan (H.T.); Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
(N.M., J.S., C.C.); and Department of Advanced Biomedical Sciences, Federico II
University, Naples, Italy (J.S.)
| | - Gaurav S. Gulsin
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z4 (G.T., G.S.G., H.T.,
J.A.L.); Department of Heart Vessels, Cardiology Service, Lausanne University
Hospital and University of Lausanne, Lausanne, Switzerland (G.T., O.M.);
University of Leicester and the Leicester NIHR Biomedical Research Centre,
Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, England
(G.S.G.); Department of Diagnostic Radiology, Tohoku University Hospital,
Sendai, Japan (H.T.); Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
(N.M., J.S., C.C.); and Department of Advanced Biomedical Sciences, Federico II
University, Naples, Italy (J.S.)
| | - Hidenobu Takagi
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z4 (G.T., G.S.G., H.T.,
J.A.L.); Department of Heart Vessels, Cardiology Service, Lausanne University
Hospital and University of Lausanne, Lausanne, Switzerland (G.T., O.M.);
University of Leicester and the Leicester NIHR Biomedical Research Centre,
Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, England
(G.S.G.); Department of Diagnostic Radiology, Tohoku University Hospital,
Sendai, Japan (H.T.); Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
(N.M., J.S., C.C.); and Department of Advanced Biomedical Sciences, Federico II
University, Naples, Italy (J.S.)
| | - Niya Mileva
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z4 (G.T., G.S.G., H.T.,
J.A.L.); Department of Heart Vessels, Cardiology Service, Lausanne University
Hospital and University of Lausanne, Lausanne, Switzerland (G.T., O.M.);
University of Leicester and the Leicester NIHR Biomedical Research Centre,
Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, England
(G.S.G.); Department of Diagnostic Radiology, Tohoku University Hospital,
Sendai, Japan (H.T.); Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
(N.M., J.S., C.C.); and Department of Advanced Biomedical Sciences, Federico II
University, Naples, Italy (J.S.)
| | - Jeroen Sonck
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z4 (G.T., G.S.G., H.T.,
J.A.L.); Department of Heart Vessels, Cardiology Service, Lausanne University
Hospital and University of Lausanne, Lausanne, Switzerland (G.T., O.M.);
University of Leicester and the Leicester NIHR Biomedical Research Centre,
Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, England
(G.S.G.); Department of Diagnostic Radiology, Tohoku University Hospital,
Sendai, Japan (H.T.); Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
(N.M., J.S., C.C.); and Department of Advanced Biomedical Sciences, Federico II
University, Naples, Italy (J.S.)
| | - Olivier Muller
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z4 (G.T., G.S.G., H.T.,
J.A.L.); Department of Heart Vessels, Cardiology Service, Lausanne University
Hospital and University of Lausanne, Lausanne, Switzerland (G.T., O.M.);
University of Leicester and the Leicester NIHR Biomedical Research Centre,
Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, England
(G.S.G.); Department of Diagnostic Radiology, Tohoku University Hospital,
Sendai, Japan (H.T.); Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
(N.M., J.S., C.C.); and Department of Advanced Biomedical Sciences, Federico II
University, Naples, Italy (J.S.)
| | - Jonathon A. Leipsic
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z4 (G.T., G.S.G., H.T.,
J.A.L.); Department of Heart Vessels, Cardiology Service, Lausanne University
Hospital and University of Lausanne, Lausanne, Switzerland (G.T., O.M.);
University of Leicester and the Leicester NIHR Biomedical Research Centre,
Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, England
(G.S.G.); Department of Diagnostic Radiology, Tohoku University Hospital,
Sendai, Japan (H.T.); Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
(N.M., J.S., C.C.); and Department of Advanced Biomedical Sciences, Federico II
University, Naples, Italy (J.S.)
| | - Carlos Collet
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z4 (G.T., G.S.G., H.T.,
J.A.L.); Department of Heart Vessels, Cardiology Service, Lausanne University
Hospital and University of Lausanne, Lausanne, Switzerland (G.T., O.M.);
University of Leicester and the Leicester NIHR Biomedical Research Centre,
Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, England
(G.S.G.); Department of Diagnostic Radiology, Tohoku University Hospital,
Sendai, Japan (H.T.); Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
(N.M., J.S., C.C.); and Department of Advanced Biomedical Sciences, Federico II
University, Naples, Italy (J.S.)
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29
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Martins VF, Hsiao A, Kligerman S, Brouha SS. Left Circumflex Coronary Artery-to-Coronary Sinus Fistula with Coronary Sinus Ostial Atresia and a Persistent Left Superior Vena Cava in an Adult Patient. Radiol Cardiothorac Imaging 2022; 4:e210249. [PMID: 35782758 PMCID: PMC8893212 DOI: 10.1148/ryct.210249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 12/14/2021] [Accepted: 01/03/2022] [Indexed: 06/15/2023]
Abstract
Understanding of coronary sinus (CS) anatomy and abnormalities is of critical importance due to their use in interventional procedures. Herein, the authors report a rare case of an asymptomatic 72-year-old man with a left circumflex coronary artery-to-CS fistula, together with CS ostial atresia and persistent left superior vena cava. These findings are described using both cardiac CT angiography and MRI with four-dimensional flow for anatomic and functional assessment. Keywords: Cardiac, Coronary Sinus, Aneurysms, Fistula, CT Angiography, MR Imaging Supplemental material is available for this article. © RSNA, 2022.
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Rubimbura V, Girod G, Delabays A, Meier D, Rotzinger DC, Muller O, Qanadli SD, Eeckhout É. Case Report: Coronary-Pulmonary Fistula Closure by Percutaneous Approach: Learning From Mistakes. Front Cardiovasc Med 2022; 8:779716. [PMID: 35146007 PMCID: PMC8823088 DOI: 10.3389/fcvm.2021.779716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 12/06/2021] [Indexed: 12/02/2022] Open
Abstract
Coronary-pulmonary artery fistulas (CPAF) are congenital vascular anomalies detected incidentally in most cases. When a significant left-right shunt exists, surgical, or percutaneous treatment is indicated. We describe a challenging case of CPAF closure, by percutaneous approach, in a patient symptomatic for dyspnea and evidence of a significant left-right shunt. A first attempt to close the fistula was performed implanting a vascular plug but it quickly embolized. The plug was successfully retrieved. In a second attempt, we deployed several coils before implanting the vascular plug with total closure of the fistula. The combination of plugs and coils is associated with a higher success rate of closure.
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Affiliation(s)
- Vladimir Rubimbura
- Cardiology Department, Lausanne University Hospital, Lausanne, Switzerland
- Cardiology Unit, Ensemble Hospitalier de la Côte, Morges, Switzerland
- *Correspondence: Vladimir Rubimbura
| | - Grégoire Girod
- Cardiology Department, Lausanne University Hospital, Lausanne, Switzerland
- Cardiology Department, Sion Hospital, Sion, Switzerland
| | - Alain Delabays
- Cardiology Department, Lausanne University Hospital, Lausanne, Switzerland
- Cardiology Unit, Ensemble Hospitalier de la Côte, Morges, Switzerland
| | - David Meier
- Cardiology Department, Lausanne University Hospital, Lausanne, Switzerland
| | - David C. Rotzinger
- Cardiology Department, Lausanne University Hospital, Lausanne, Switzerland
- Radiology Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Olivier Muller
- Cardiology Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Salah D. Qanadli
- Cardiology Department, Lausanne University Hospital, Lausanne, Switzerland
- Radiology Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Éric Eeckhout
- Cardiology Department, Lausanne University Hospital, Lausanne, Switzerland
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Subramanian A, Jayranganath M, Bharath A, Barthur A, Sastry UK, M. Moorman A. Congenital systemic arteriovenous fistulas: Interventional strategies and embryological perspectives. Ann Pediatr Cardiol 2022; 15:138-146. [PMID: 36246751 PMCID: PMC9564402 DOI: 10.4103/apc.apc_143_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/05/2021] [Accepted: 10/03/2021] [Indexed: 11/10/2022] Open
Abstract
Background: Data on congenital systemic arteriovenous fistulas are largely based on individual case reports. A true systemic arteriovenous fistula needs to be differentiated from other vascular malformations like capillary or venous hemangiomas, which are far more common. Objectives: We sought to identify the varied symptoms, diagnostic challenges, describe interventional treatment options, and postulate an embryological basis for this uncommonly described entity. Methods: This is a descriptive study of a cohort of systemic arteriovenous fistulas seen in the department of pediatric cardiology at a tertiary cardiac institute from 2010 to 2020, with prospective medium-term follow-up. A total of seven cases were identified. The diagnosis was confirmed by computed tomographic imaging, magnetic resonance angiography, or conventional angiography. Results: All were successfully closed using duct occluders or embolization coils with no recurrence in six cases over a median duration of follow-up of 48 months (interquartile range: 16; 36–52 months). Four of the seven cases underwent follow-up imaging using echocardiography or ultrasound. Conclusion: The incidence of congenital systemic arteriovenous fistulas is low and accounted for 0.009% of pediatric outpatients seen over 10 years at our institute. The spectrum of clinical presentation varies from an innocuous swelling or a pulsating mass to frank heart failure. Strong clinical suspicion and advanced imaging modalities have helped identify some hitherto undescribed connections. Large malformations with multiple communications may persist or recur despite transcatheter closure.
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Lee HJ, Kim JY. Coronary Artery Anomaly, What Radiologist Should Know? JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:84-101. [PMID: 36237368 PMCID: PMC9238192 DOI: 10.3348/jksr.2021.0169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 12/17/2021] [Accepted: 12/24/2021] [Indexed: 11/15/2022]
Abstract
심장 전산화단층촬영(이하 CT)은 현재 관상동맥기형을 진단하고, 평가하는 가장 정확한 진단 도구로 자리매김하였으며, 심장 CT 촬영 건수가 증가함에 따라 관상동맥기형을 종종 관찰할 수 있다. 본 종설은 관상동맥기형에서 영상의학과 의사들이 꼭 알아야 할 대표적인 기형의 CT 소견들에 대해 다루었다. 관상동맥기형의 종류를 3부분 즉, 기시부, 동맥 내, 그리고 연결 부위로 나누어 설명하였으며, 임상에서 볼 수 있는 대표적인 기형들 중심으로 다루었다. 특히 혈역학적 이상을 유발하거나, 급사의 위험이 있는 기형들의 CT상 위험한 해부학적 소견에 대해서는 자세히 기술하였다.
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Affiliation(s)
- Hyun Jin Lee
- Department of Radiology, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Jin Young Kim
- Department of Radiology, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
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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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Hang K, Zhao G, Su W, Bao G, Zhao Q, Jiao Z, Tian Z, Zhang H, Nie L, Luo R, Li L, Huang M, Shi L, Li S. Coronary artery-to-pulmonary artery fistula in adults: evaluation with 320-row detector computed tomography coronary angiography. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1434. [PMID: 34733986 PMCID: PMC8506747 DOI: 10.21037/atm-21-4404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/18/2021] [Indexed: 11/24/2022]
Abstract
Background To analyze the imaging features of coronary artery-to-pulmonary artery fistula (CPAF) on coronary computed tomography angiography (CCTA). Methods This was a retrospective study of 3,975 patients who underwent 320 row detector CCTA examinations in our hospital from May 2015 to July 2020. A total of 22 patients who diagnosed with CPAF were reviewed for CCTA imaging characteristics, including the origin, number, blood volume, opening size, and course of fistula vessels, and the drainage site, size, and imaging features of the fistula. All cases were analyzed for the presence of coronary atherosclerotic plaque and that of deficient left ventricular myocardial perfusion. Results A total of 22 CPAF cases detected by CCTA were collected (men, 11; women, 11; median age, 59.6±10.1 years). There were 7, 10, and 5 cases detected with 1, 2, and 3 fistula vessels, respectively, among which 4 originated from the left coronary artery, 4 from the right coronary artery, and 14 had bilateral origins. There were 10 cases in which the fistula vessels presented as a worm-like tortuous dilation with (n=5) or without (n=5) aneurysm, while 12 cases showed malformed vascular networks with (n=8) or without (n=4) aneurysm, respectively. The calculated incidence of aneurysm formation was 59.09%, and fistula vessels with an aneurysm had larger blood volume than those without. All fistula showed a single drainage site, with an average diameter of 2.81±1.48 mm where the diameter of fistula with aneurysm was larger than that without. The fistula vessels drained into the left anterolateral and anterior walls of main pulmonary artery and the proximal left inferior PA, respectively. Typical jet sign, smoke sign, and isodensity sign were presented in 22, 14 and 1 case, respectively. For the coexistent abnormalities analyzed in 22 cases, 17 participants with CPAF demonstrated hypoperfusion of the fistula vessels, and 11 demonstrated calcified plaque accompanied with luminal stenosis to different degrees. Conclusions The 320-row detector CCTA can comprehensively characterize the morphological features of CPAF, which is an optimal choice for physicians to make an accurate assessment before formulating patient management strategies.
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Affiliation(s)
- Kaibing Hang
- Naval Medical Center of People's Liberation Army, Shanghai, China
| | - Guoli Zhao
- Naval Medical Center of People's Liberation Army, Shanghai, China
| | - Weiwei Su
- Naval Medical Center of People's Liberation Army, Shanghai, China
| | - Guangjin Bao
- Naval Medical Center of People's Liberation Army, Shanghai, China
| | - Qi Zhao
- Naval Medical Center of People's Liberation Army, Shanghai, China
| | - Zizhen Jiao
- Naval Medical Center of People's Liberation Army, Shanghai, China
| | - Zhanqi Tian
- Naval Medical Center of People's Liberation Army, Shanghai, China
| | - Hui Zhang
- Naval Medical Center of People's Liberation Army, Shanghai, China
| | - Lin Nie
- Naval Medical Center of People's Liberation Army, Shanghai, China
| | - Rui Luo
- Naval Medical Center of People's Liberation Army, Shanghai, China
| | - Lifang Li
- Naval Medical Center of People's Liberation Army, Shanghai, China
| | - Min Huang
- Naval Medical Center of People's Liberation Army, Shanghai, China
| | - Lijing Shi
- Department of Radiology, Sixth Medical Center of People's Liberation Army General Hospital, Beijing, China
| | - Shuping Li
- Naval Medical Center of People's Liberation Army, Shanghai, China
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35
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Postsurgical coronary artery fistula after tetralogy of fallot repair. CIRUGIA CARDIOVASCULAR 2021. [DOI: 10.1016/j.circv.2021.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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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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37
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Benetti F, Gonzalez J, Abuin G. Coronary artery fistula, where are we now? J Card Surg 2021; 36:4623-4624. [PMID: 34617328 DOI: 10.1111/jocs.16057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 10/01/2021] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Gustavo Abuin
- Universidad de Buenos Aires, Buenos Aires, Argentina
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38
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Firouzi A, Alemzadeh-Ansari MJ, Mohebbi B, Khajali Z, Khalilipur E, Baay M, Bayatian A, Taherian M, Khosropour A, Hosseini Z. Diverse Transcatheter Closure Strategies in Coronary Artery Fistulas A State-of-the-Art Approach. Curr Probl Cardiol 2021; 47:101010. [PMID: 34599986 DOI: 10.1016/j.cpcardiol.2021.101010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 09/22/2021] [Indexed: 12/24/2022]
Abstract
Coronary artery fistulas (CAFs) are accounted as the most congenital coronary anomalies. As their natural course is progressive dilatation of the feeder arteries and the fistula tract, so, catastrophic complications are frequently illustrated by aging. Even in those with asymptomatic small fistulas, close follow-up is mandatory to prevent subsequent sequelas. In patients with medium or large-sized fistulas, irrespective of symptoms, closure (either by surgical ligation or transcatheter closure) is recommended. In the current era of advances in the equipment and devices and also innovations in percutaneous closure techniques and preprocedural imaging, TCC is now regarded as the preferred strategy for CAF closure except in some high-risk cases. So, by appropriate case selection modalities, pre-procedural planning, and determining the closure techniques, recent small case-series studies have been reported good final angiographic and clinical results by TCC. In this article, we have introduced several transcatheter closure techniques by details; also, we have recommended more multi-center trials with long-term clinical follow-up to address the best treatment options in these patients.
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Affiliation(s)
- Ata Firouzi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Javad Alemzadeh-Ansari
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Bahram Mohebbi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Khajali
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ehsan Khalilipur
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Baay
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ayatollah Bayatian
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Maisam Taherian
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Khosropour
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Hosseini
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
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Goo HW. Imaging Findings of Coronary Artery Fistula in Children: A Pictorial Review. Korean J Radiol 2021; 22:2062-2072. [PMID: 34564965 PMCID: PMC8628148 DOI: 10.3348/kjr.2021.0336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/09/2021] [Accepted: 07/21/2021] [Indexed: 11/25/2022] Open
Abstract
Coronary artery fistula, defined as an abnormal communication between the coronary arteries and a cardiac chamber (most commonly) or a thoracic great vessel, may result in hemodynamically significant problems due to vascular shunting in children. Echocardiography, cardiac catheterization, cardiac MRI, and cardiac CT may be used to evaluate coronary artery fistula in children. Recently, CT has played a pivotal role for the accurate diagnosis of coronary artery fistula in children. Surgical or interventional treatment is performed for hemodynamically significant coronary artery fistulas. In this pictorial review, the detailed imaging findings of coronary artery fistula in children are described.
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Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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40
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Kumar P. Congenital Coronary Artery-to-Pulmonary Artery Fistula with Anomalous Origin of Right Coronary Artery from Pulmonary Artery: A Case of "Double Trouble". Radiol Cardiothorac Imaging 2021; 3:e210003. [PMID: 34498004 PMCID: PMC8415169 DOI: 10.1148/ryct.2021210003] [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] [Received: 01/07/2021] [Revised: 06/04/2021] [Accepted: 06/21/2021] [Indexed: 06/13/2023]
Abstract
Congenital coronary artery fistula is a rare coronary anomaly. Its clinical significance focuses mainly on the mechanism of coronary steal phenomenon. A combination of left main (LM) coronary artery-to-main pulmonary artery (MPA) fistula with anomalous origin of right coronary artery from the pulmonary artery (ARCAPA) was encountered in a 3-month-old infant who presented with tachypnea. Evaluation with echocardiography and CT confirmed the diagnosis. The patient underwent surgical ligation of LM-to-MPA fistula with direct reimplantation of ARCAPA to aortic root. Keywords: Pediatrics, CT, CT-Angiography, Echocardiography © RSNA, 2021.
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Osawa T, Ito Y, Koizumi T. Rare case of congenital coronary artery fistula coexistent and coalesced with aortopulmonary fistula. BMJ Case Rep 2021; 14:14/7/e244035. [PMID: 34301690 PMCID: PMC8311308 DOI: 10.1136/bcr-2021-244035] [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: 11/23/2022] Open
Abstract
Coronary artery fistula (CAF) is an uncommon congenital heart disease. Furthermore, aortopulmonary fistula is a rare congenital heart disease of adult onset. We report the case of a 79-year-old man who presented with chest pain. ECG-gated cardiac CT and coronary artery angiography revealed an anomalous vessel arising from the right coronary cusp and a CAF from the left coronary descending artery. These fistulas coalesced and drained into the same portion of the pulmonary artery. Haemodynamic studies revealed that the estimated systemic-to-pulmonary flow ratio was 1.18. The mean pulmonary pressure was 14 mm Hg. We decided against surgical intervention due to his advanced age and lack of heart failure symptoms. The patient did not have any worsening heart failure and chest pain on follow-up. This was a rare case of CAF coexistent and coalesced with an aortopulmonary fistula.
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Affiliation(s)
- Takumi Osawa
- Department of Cardiovascular Medicine, Mito Medical Center, Mito, Ibaraki, Japan
| | - Yuta Ito
- Department of Cardiovascular Medicine, Mito Medical Center, Mito, Ibaraki, Japan
| | - Tomomi Koizumi
- Department of Cardiovascular Medicine, Mito Medical Center, Mito, Ibaraki, Japan
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Yokoyama S, Nagao K, Higashida A, Aoki M, Yamashita S, Yamashita A, Doi T, Fukahara K, Yoshimura N. Surgical repair of a right coronary aneurysm with a coronary artery fistula to the right atrium. J Surg Case Rep 2021; 2021:rjab286. [PMID: 34257902 PMCID: PMC8271032 DOI: 10.1093/jscr/rjab286] [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: 05/24/2021] [Accepted: 06/14/2021] [Indexed: 11/12/2022] Open
Abstract
A coronary artery fistula is a rare condition caused by abnormal coronary artery embryological development. Although most cases are asymptomatic, in some, the large shunt volume and the myocardial ischemia due to the steal phenomenon require surgical treatment. We present the case of a 40-year-old woman who presented with angina on exertion. Enhanced computed tomography showed a giant right coronary artery (RCA) aneurysm with an RCA-to-right atrium fistula. Because of the presence of symptoms and the presence of large fistulous tract, the patient was considered a surgical candidate. The procedure was performed under cardiopulmonary bypass. Ligation and closure of the fistula were performed in combination with dissection of the enlarged main trunk of the RCA and coronary artery bypass using the internal thoracic artery because of its potential for long-term patency. The postoperative course was uneventful.
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Affiliation(s)
- Shigeki Yokoyama
- Department of Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Kanetsugu Nagao
- Department of Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Akihiko Higashida
- Department of Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Masaya Aoki
- Department of Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Shigeyuki Yamashita
- Department of Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Akio Yamashita
- Department of Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Toshio Doi
- Department of Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Kazuaki Fukahara
- Department of Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Naoki Yoshimura
- Department of Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan
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An X, Guo S, Dong H, Tang Y, Li L, Duan X, Ye S. Congenital coronary artery-to-pulmonary fistula with giant aneurysmal dilatation and thrombus formation: a case report and review of literature. BMC Cardiovasc Disord 2021; 21:273. [PMID: 34088261 PMCID: PMC8176730 DOI: 10.1186/s12872-021-02077-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/24/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Coronary artery-to-pulmonary artery fistula is a rare disorder characterized by abnormal vascular communication between the coronary artery and pulmonary artery. While most patients remain asymptomatic, some might exhibit symptoms of myocardial ischemia, congestive heart failure, or even sudden cardiac death if coronary aneurysm, thrombosis, infective carditis, or other congenital cardiac defects coexist. Case presentation We present a 66-year-old male complaining of angina pectoris with a history of hypertension and active smoking. He was diagnosed with a coronary aneurysm based on coronary computed tomography angiography. We subsequently identified a coronary artery-to-pulmonary artery fistula with giant aneurysmal dilation on coronary angiography. Ultimately we conducted surgery ligation and aneurysmorrhaphy. During surgery, we discovered newly formed thrombus within the aneurysmal cavity. Histological analysis of the aneurysmal wall supported the diagnosis of the congenital disorder. Our patient was successfully discharged and remained asymptomatic at two months of follow-up. CONCLUSION We presented a rare and complex combination of congenital coronary artery-to pulmonary artery fistula, giant coronary aneurysmal dilatation, and thrombosis through multi-modality evaluations.
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Affiliation(s)
- Xuanqi An
- State Key Laboratory of Cardiovascular Disease, Center of Internal Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Rd, Xicheng District, Beijing, 100037, People's Republic of China
| | - Shaoxian Guo
- State Key Laboratory of Cardiovascular Disease, Center of Surgery, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China
| | - Huawei Dong
- State Key Laboratory of Cardiovascular Disease, Center of Surgery, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China
| | - Yida Tang
- State Key Laboratory of Cardiovascular Disease, Center of Internal Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Rd, Xicheng District, Beijing, 100037, People's Republic of China
| | - Lin Li
- State Key Laboratory of Cardiovascular Disease, Center of Internal Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Rd, Xicheng District, Beijing, 100037, People's Republic of China
| | - Xuejing Duan
- State Key Laboratory of Cardiovascular Disease, Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China
| | - Shaodong Ye
- State Key Laboratory of Cardiovascular Disease, Center of Internal Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Rd, Xicheng District, Beijing, 100037, People's Republic of China.
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Yoshihara S, Yaegashi T, Matsunaga M, Kurata M, Naito M. Multimodality Imaging in a Case of Coronary to Pulmonary Artery Fistula With Multiple Aneurysms via a Vieussens Arterial Ring. Circ Cardiovasc Imaging 2021; 14:e012178. [PMID: 34034503 DOI: 10.1161/circimaging.120.012178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Shu Yoshihara
- Departments of Diagnostic Radiology (S.Y., M.N.), Iwata City Hospital, Japan
| | - Taku Yaegashi
- Radiological Technology (T.Y.), Iwata City Hospital, Japan
| | | | | | - Masaaki Naito
- Departments of Diagnostic Radiology (S.Y., M.N.), Iwata City Hospital, Japan
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45
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Mori A, Inoue S, Orikasa H, Yoshimoto T, Konishi H. Coronary Artery Fistula Aneurysm: Pathological Analysis After Surgery. Cureus 2021; 13:e14903. [PMID: 34113513 PMCID: PMC8183465 DOI: 10.7759/cureus.14903] [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: 11/11/2022] Open
Abstract
An asymptomatic 75-year-old woman was identified with a 40-mm-sized, round-shaped lesion beside the pulmonary artery on computed tomography (CT). Coronary angiography showed a coronary artery fistula (CAF) with an aneurysm branching from the left anterior descending artery toward the pulmonary artery. The CAF aneurysm (CAFA) was resected and coronary artery bypass graft surgery using the left internal thoracic artery was performed successfully. Pathological analysis revealed that medial depletion similar to segmental arterial mediolysis (SAM) may contribute to aneurysm formation.
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Affiliation(s)
- Atsuo Mori
- Cardiovascular Surgery, Kawasaki Municipal Hospital, Kawasaki, JPN
| | - Shinya Inoue
- Cardiovascular Surgery, Kawasaki Municipal Kawasaki Hospital, Kawasaki, JPN
| | - Hideki Orikasa
- Pathology, Kawasaki Municipal Kawasaki Hospital, Kawasaki, JPN
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46
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Muhtaroglu M, Lafci Fahrioglu S, Ilgi S. Case From the Eyes of an Anatomist: Fistula Between Proximal of Left Anterior Descending Artery to Pulmonary Artery. J Med Cases 2021; 12:213-215. [PMID: 34434460 PMCID: PMC8383527 DOI: 10.14740/jmc3676] [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: 02/07/2021] [Accepted: 02/22/2021] [Indexed: 11/11/2022] Open
Abstract
Advanced diagnostic systems and screening services for health care have made it possible to improve the detection of congenital cardio-vascular abnormalities, including coronary artery variations. Many coronary artery fistulas are congenital, and this can also be reported in patients with normal heart anatomy. In this report, we present a patient with a fistula between left anterior descending artery and pulmonary artery which was diagnosed incidentally with conventional angiography.
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Affiliation(s)
- Musa Muhtaroglu
- Anatomy Department, Faculty of Medicine, Near East University, Nicosia, Cyprus
| | | | - Sezgin Ilgi
- Anatomy Department, Faculty of Medicine, Near East University, Nicosia, Cyprus
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47
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Peighambari M, Pakbaz M, Alizadehasl A, Hosseini S, Pouraliakbar H. A Case of Coronary Cameral Fistula: When and How to Intervene? J Tehran Heart Cent 2021; 15:189-194. [PMID: 34178089 PMCID: PMC8217193 DOI: 10.18502/jthc.v15i4.5946] [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: 11/24/2022] Open
Abstract
Coronary artery fistulas constitute a rare anomaly defined as an abnormal communication between a coronary artery and a great vessel or any cardiac chamber. The majority of these fistulas arise from the right coronary artery and the left anterior descending coronary artery; the circumflex coronary artery is rarely involved. We present an unusual case of a coronary artery fistula in a middle-aged woman who presented with symptoms of heart failure and abnormal auscultation. Echocardiography and conventional and computed tomography angiography showed that the coronary fistula originated from the left circumflex coronary artery and drained majorly into the right ventricle. Given the complex anatomy of the fistula, we managed it surgically rather than percutaneously. There were no complications early after surgery and at 1 year's follow-up.
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Affiliation(s)
- Mehdi Peighambari
- Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Marziyeh Pakbaz
- Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Azin Alizadehasl
- Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Saeid Hosseini
- Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Pouraliakbar
- Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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48
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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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49
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Singh J, Singh H. Congenital right coronary artery-to-right ventricular outflow tract fistula device closure with migration: retrieval of device after eight years. Asian Cardiovasc Thorac Ann 2020; 29:417-419. [PMID: 33183062 DOI: 10.1177/0218492320974859] [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: 11/17/2022]
Abstract
Coronary artery congenital fistulas are rare disorders. Transcatheter closure is the primary method of closure. Device migration is a known complication, for which surgical retrieval is required.
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Affiliation(s)
- Jagjit Singh
- Department of Cardiothoracic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harkant Singh
- Department of Cardiothoracic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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50
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Battisha A, Madoukh B, Sheikh O, Altibi A, Sheikh S, Al-Sadawi M. Coronary Fistula Between Left Anterior Descending Artery (LAD) and Pulmonary Artery (PA) Leading to Sudden Cardiac Death: Case Report with Literature Review. Curr Cardiol Rev 2020; 16:98-102. [PMID: 31593531 PMCID: PMC7460707 DOI: 10.2174/1573403x15666191008100848] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 08/14/2019] [Accepted: 08/27/2019] [Indexed: 11/22/2022] Open
Abstract
Coronary Artery Fistulas (CAF) are inappropriate connections between a coronary artery and a major vessel or a cardiac chamber. These fistulas may or may not present with symptoms, but they need to be detected as early as possible in order to decide the most appropriate treatment methodology (i.e. surgery vs. conservative management). We report the case of a 67-year-old female with no modifiable cardiovascular risk factors who had an unwitnessed sudden death at home during her ongoing evaluation of a fistula detected incidentally between the Left Anterior Descending Artery (LAD) and the Pulmonary Artery (PA). This case highlights that early diagnosis and treatment of symptomatic CAF are crucial to minimize the risk of sudden cardiac death. Although the symptomatic fistula of LAD to PA has been reported in the literature multiple times, it has been rarely reported that this fistula can result in sudden cardiac death.
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Affiliation(s)
- Ayman Battisha
- Department of Internal Medicine, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts, MA 01003, United States
| | - Bader Madoukh
- Department of Internal Medicine, Overland Park Regional Medical Center-HCA Midwest Health, Overland Park, Kansas, KS, United States
| | - Omar Sheikh
- Department of Internal Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 77030, United States
| | - Ahmed Altibi
- Department of Internal Medicine, Henry Ford Allegiance Health, Jackson, MI, United States
| | - Shakil Sheikh
- Department of Cardiology, State University of New York, Downstate Medical Center, Brooklyn, New York, NY 12222, United States
| | - Mohammed Al-Sadawi
- Department of Internal Medicine, State University of New York, Downstate Medical Center, Brooklyn, New York, NY 12222, United States
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