Coronary artery fistula draining into the left ventricle

A Coronary Artery-left Ventricular Fistula through the Sinusoid

A 78-year-old woman was referred to our hospital because of repetitive suppurative arthritis at the artificial left knee joint. Her plasma brain natriuretic peptide level was 122 pg/mL. A 12-lead electrocardiogram showed a QS pattern in the inferior leads. A two-dimensional echocardiogram revealed hypokinesis at the inferior wall and hypertrophy at the apical lateral wall. Color flow imaging revealed this hypertrophic region to be a myocardial sinusoid, demonstrating diastolic coronary to left ventricular flow and early systolic flow vice versa. This was a very rare case of coronary to left ventricular fistula through a sinusoid without cyanotic congenital heart disease or severe coronary artery disease.

A coronary artery fistula having connection between 2 coronary arteries and the left ventricle: A case report

RATIONALE

Cases of coronary artery fistula having a connection with the cardiac cavity are rare. Here, we report a case in which 2 coronary arteries empty into the left ventricular cavity together.

PATIENT CONCERNS

A 63-year-old woman who was diagnosed as having hypertension 20 years prior presented with dyspnea.

DIAGNOSES

The coronary angiography revealed coronary artery fistula.

INTERVENTIONS

Chest X-ray showed pulmonary edema. Transthoracic echocardiography revealed moderately decreased left ventricular (LV) function and increased LV end-diastolic volume and mass index. Coronary angiography and cardiac computed tomography revealed that 2 coronary arteries joined together at the distal end and directly drained into the left ventricular cavity bypassing the myocardial capillary vessels. We started medical treatment for heart failure with an angiotensin-converting-enzyme inhibitor, loop diuretic, and spironolactone.

OUTCOMES

The pulmonary edema improved rapidly. The patient did not experience dyspnea after discharge, and follow-up echocardiography showed improved cardiac function.

MAIN LESSON

Coronary artery fistula could be found incidentally on coronary angiography performed for varied reasons. Physicians must decide carefully whether the fistula needs to be treated in view of the clinical context.

Coronary Artery Fistulas: Case Series and Literature Review

Congenital coronary artery fistulas are rare anomalies. As coronary angiography and multidetector computed tomography have become more accessible, they have been increasingly used in the investigation of chest pain and heart failure. Coronary artery fistulas are often an incidental finding, which raises the question of how patients with this condition should be managed. Intervention with either transcatheter closure or surgical closure is often technically possible. Many patients are asymptomatic early after closure. However, follow-up studies have shown post-closure sequelae, such as residual leakage, thrombosis with or without myocardial infarction, and coronary stenosis. Therefore, there has been a shift from intervention towards watchful waiting in asymptomatic patients. In this article, we review the published literature on the natural history and treatment outcomes in individuals with coronary artery fistulas. We present case reports from our clinic and discuss the management of incidental findings of coronary artery fistulas.

Isolated right ventricular hypoplasia caused by giant aneurysm of right coronary artery to left ventricle fistula in an adult: a case report

Background

Right ventricular hypoplasia (RVH) is often caused by tricuspid valve atresia and pulmonary valve atresia. this condition leads to low right ventricular blood volume and right ventricular maldevelopment. But, in adults, the main cause of RVH may also be associated with alloplasia of the right coronary artery, which results in an insufficient blood supply to the right ventricular myocardium. Isolated RVH caused by a right coronary artery fistula is very rare and requires immediate treatment.

Case presentation

We herein report a case involving a 45-year-old man who presented with isolated RVH caused by a giant aneurysm from the right coronary artery to a left ventricle fistula. Echocardiography showed that the right coronary artery was extremely tortuous and obviously dilated with a huge aneurysm. A fistula drained from the right coronary artery into the left ventricle. Moreover, the right heart chamber was significantly collapsed due to extrinsic compression of multiple tortuous, dilated vascular structures. The patient was referred to cardiac surgery. The giant aneurysm was resected, and the proximal and distal openings were closed directly. The fistula was also closed directly, and bypasses were constructed sequentially from the ascending aorta to three branches of the right coronary artery.

Conclusions

Although standard therapeutic strategies of isolated RVH secondary to a right coronary artery fistula are not well established because of the rarity of this condition, our clinical results show that diagnostic echocardiography, coronary artery angiography, and cardiac computed tomography angiography followed by surgical treatment may be an effective management option.