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Robu M, Radulescu B, Nayyerani R, Enache R, Stiru O, Iosifescu A, Olaru G, Ciomag (Ianula) R, Iliescu VA, Moldovan H. Management of a Rare Case of Multiple Coronary Artery Fistulas Associated with Ascending Aortic and Root Aneurysm: Case Report and Review of Literature. J Clin Med 2024; 13:2297. [PMID: 38673570 PMCID: PMC11050765 DOI: 10.3390/jcm13082297] [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: 02/20/2024] [Revised: 04/11/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
Coronary artery fistulas draining into the left ventricle is a rare finding. They can be associated with other congenital cardiac anomalies like ventricular septal defect or tetralogy of Fallot. While most of them are asymptomatic, they can lead to severe cardiac complications like infective endocarditis, heart failure, or myocardial ischemia. Symptomatic coronary artery fistulas can be managed surgically or percutaneously. We present a case of a 61-year-old male patient with both left anterior descending artery and right coronary artery fistulas draining into the left ventricle associated with ascending aorta and root aneurysm. Preoperative assessment for myocardial ischemia and the size and location of the fistulas was performed. The echocardiography stress test was negative. Surgery consisted of replacement of the ascending aorta and reconstruction of the noncoronary sinus with a Dacron patch with aortic valve preservation and no intervention for the coronary artery fistulas. The surgical strategy was adapted for cardioplegia administration to compensate for the volume of coronary blood drained into the left ventricle and for better protection of the distal myocardium.
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Affiliation(s)
- Mircea Robu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.R.); (R.N.); (O.S.); (A.I.); (R.C.); (V.A.I.); (H.M.)
- Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania;
| | - Bogdan Radulescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.R.); (R.N.); (O.S.); (A.I.); (R.C.); (V.A.I.); (H.M.)
- Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania;
| | - Reza Nayyerani
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.R.); (R.N.); (O.S.); (A.I.); (R.C.); (V.A.I.); (H.M.)
- Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania;
| | - Robert Enache
- Radiology Department, Fundeni Clinical Institute, 022322 Bucharest, Romania;
| | - Ovidiu Stiru
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.R.); (R.N.); (O.S.); (A.I.); (R.C.); (V.A.I.); (H.M.)
- Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania;
| | - Andrei Iosifescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.R.); (R.N.); (O.S.); (A.I.); (R.C.); (V.A.I.); (H.M.)
- Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania;
| | - Georgiana Olaru
- Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania;
| | - Raluca Ciomag (Ianula)
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.R.); (R.N.); (O.S.); (A.I.); (R.C.); (V.A.I.); (H.M.)
- Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania;
| | - Vlad Anton Iliescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.R.); (R.N.); (O.S.); (A.I.); (R.C.); (V.A.I.); (H.M.)
- Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania;
| | - Horatiu Moldovan
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.R.); (R.N.); (O.S.); (A.I.); (R.C.); (V.A.I.); (H.M.)
- Department of Cardiovascular Surgery, Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania
- Academy of Romanian Scientists, 050711 Bucharest, Romania
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Kumar R, Kumar J, O'Connor C, Ullah I, Tyrell B, Pearson I, Matiullah S, Bainey K. Coronary Artery Fistula: A Diagnostic Dilemma. Interv Cardiol 2023; 18:e25. [PMID: 38125927 PMCID: PMC10731518 DOI: 10.15420/icr.2022.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 06/01/2023] [Indexed: 12/23/2023] Open
Abstract
Coronary artery fistula (CAF), although one of the rare coronary anomalies, is becoming increasingly more detectable in the recent years due to advancements in cardiac diagnostic imaging. Its long-term prognostic implications and importance for the cardiovascular system remain a dilemma for cardiologists and patients. Based on a variety of haemodynamic symptoms and complications, cardiologists must be aware of the characteristics of CAF and the diagnostic importance of multi-slice CT in evaluation, pre-procedural management and follow-up. Both surgical and percutaneous options are available for symptomatic patients or those with complications, while management of asymptomatic CAF remains a viable alternative.
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Affiliation(s)
- Rajesh Kumar
- Department of Cardiology, St James’s HospitalDublin, Ireland
- Mazankowski Alberta Heart Institute, University of Alberta HospitalEdmonton, Canada
| | - Jathinder Kumar
- Department of Cardiology, St James’s HospitalDublin, Ireland
| | - Cormac O'Connor
- Department of Cardiology, St James’s HospitalDublin, Ireland
| | - Ihsan Ullah
- Department of Cardiology, St James’s HospitalDublin, Ireland
| | - Benjamin Tyrell
- Mazankowski Alberta Heart Institute, University of Alberta HospitalEdmonton, Canada
| | - Ian Pearson
- Department of Cardiology, St James’s HospitalDublin, Ireland
| | | | - Kevin Bainey
- Mazankowski Alberta Heart Institute, University of Alberta HospitalEdmonton, Canada
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Soufiani A, Chraibi H, El-Mhadi S, Agoumy Z, Fassi Fehri Z, Fellat R, Bensouda A, Bendagha N, Moughil S. Giant circumflex artery with bilobed saccular aneurysm and right atrial fistula mimicking a bi-atrial hydatid cyst: a case report. J Surg Case Rep 2023; 2023:rjad108. [PMID: 36908687 PMCID: PMC9997557 DOI: 10.1093/jscr/rjad108] [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: 12/26/2022] [Accepted: 02/13/2023] [Indexed: 03/12/2023] Open
Abstract
Coronary artery fistulas (CAF) are rare anomalies that pose a significant diagnostic and therapeutic challenge. Most of them originate from the right coronary artery and are congenital. They are often associated with coronary aneurysms. We report the case of a 38-year-old Black man who presented with exertion dyspnea. Transthoracic echocardiography found what was thought to be a bi-atrial hydatid cyst, alongside a right atrial shunt. Cardiac magnetic resonance imaging showed a cystic lesion hypointense on T1 and T2 sequences, located next to the left atrium as well as an aneurysmal circumflex artery shunting in the right atrium. Coronary angiography and computed tomography angiography confirmed the bilobed circumflex saccular aneurysm and CAF. The patient underwent a successful surgery, which consisted of closure of the fistula using two patches. He was discharged after an uneventful postoperative course. Our case report illustrates the diagnostic difficulty of CAF and the importance of multimodal imaging.
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Affiliation(s)
- Aida Soufiani
- Cardiology A Department, Ibn Sina Hospital, Mohammed V University, Rabat, Morocco
| | - Hamza Chraibi
- Cardiology A Department, Ibn Sina Hospital, Mohammed V University, Rabat, Morocco
| | - Samah El-Mhadi
- Cardiology A Department, Ibn Sina Hospital, Mohammed V University, Rabat, Morocco
| | - Zineb Agoumy
- Cardiology A Department, Ibn Sina Hospital, Mohammed V University, Rabat, Morocco
| | - Zineb Fassi Fehri
- Cardiology A Department, Ibn Sina Hospital, Mohammed V University, Rabat, Morocco
| | - Rokya Fellat
- Cardiology A Department, Ibn Sina Hospital, Mohammed V University, Rabat, Morocco
| | - Adil Bensouda
- Cardiovascular Surgery B Department, Ibn Sina Hospital, Mohammed V University, Rabat, Morocco
| | - Nesma Bendagha
- Cardiology A Department, Ibn Sina Hospital, Mohammed V University, Rabat, Morocco
| | - Said Moughil
- Cardiovascular Surgery B Department, Ibn Sina Hospital, Mohammed V University, Rabat, Morocco
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Kim N, Cho JM. Left/right coronary artery-left ventricular fistulae with color flow image observed during transthoracic echocardiography. Coron Artery Dis 2022; 33:605-606. [PMID: 35811558 PMCID: PMC9528937 DOI: 10.1097/mca.0000000000001158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/05/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Narae Kim
- Department of Cardiology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Jin-Man Cho
- Department of Cardiology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
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Tekeli Sengul S, Karasu BB. Prevalence and characteristics of coronary artery fistula in adults: coronary angiographic analysis of 18,106 patients. KARDIOLOGIIA 2022; 62:62-66. [PMID: 35692175 DOI: 10.18087/cardio.2022.5.n1901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 10/22/2021] [Accepted: 02/03/2022] [Indexed: 06/15/2023]
Abstract
Aim Coronary artery fistula (CAF) is a rarely encountered anomaly that is characterized by an abnormal connection between a coronary artery and a cardiac chamber or a great thoracic vessel. Its incidence has not been precisely established due to the large number of undiagnosed cases and it shows heterogeneity in its anatomic configuration and clinical consequences. We aimed to assess the frequency, imaging findings, and clinical features of CAF among patients in our tertiary medical center.Material and methods The angiographic data of 18,106 consecutive adult patients who underwent coronary angiography between January 2011 and June 2013 were retrospectively analyzed.Results CAF was detected in 22 patients (0.14 %). Of these, 5 patients had bilateral fistulas (23 %). 65 % of the fistulas originated from the left anterior descending coronary artery,and 53 % drained into the pulmonary artery. The left ventricle and left atrium were the only drainage sites for left-sided coronary artery fistulas. One patient with a CAF presented with non-ST elevated myocardial infarction in the absence of an evident thrombosis.Conclusion Unlike previous reports, bilateral CAFs were more commonly encountered in this study. Contrary to most of the data in the literature, more than half of the CAFs originated from the left anterior descending coronary artery and most drained into the pulmonary artery. Rare anatomic types of CAFs were also detected.
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Multiple Coronary Fistulas as a Rare Cause of Stable Angina Pectoris. Case Rep Cardiol 2022; 2022:9372295. [PMID: 35280942 PMCID: PMC8916878 DOI: 10.1155/2022/9372295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 01/27/2022] [Accepted: 02/23/2022] [Indexed: 11/18/2022] Open
Abstract
Congenital coronary artery-left ventricular multiple microfistulas (CA-LVMMFs) are rare anomalies in adults. They are more often found in female patients, and they usually originate from the distal segments of the coronary arteries, but they can originate from a proximal segments of a coronary arteries, and these patients are likely to be identified and treated in the pediatric age group. They are mostly asymptomatic. When symptoms and complications occur, they include angina, myocardial infarction, atrial heart failure, arrhythmias, and endocarditis. The management of CA-LVMMFs is controversial, but it is generally agreed that conservative medical management is the primary treatment of choice. Our case describes a rare form of CA-LVMMFs draining into the left ventricle in a female patient presenting with fatigue, atypical anginal symptoms, atrial fibrillation, and premature ventricular complexes, without concomitant obstructive coronary artery disease.
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Chen K, Zeng Z, Li T, Chen R, Luo J, Zhou Z. Coronary artery-left ventricular multiple microfistulas, a rare disease that is easily missed: case report and literature review. J Int Med Res 2022; 50:3000605221082882. [PMID: 35225046 PMCID: PMC8894615 DOI: 10.1177/03000605221082882] [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: 11/03/2021] [Accepted: 02/04/2022] [Indexed: 11/16/2022] Open
Abstract
Coronary artery-left ventricular multiple microfistulas (CALVMMFs) are a very rare type of coronary artery fistula. Because of their special anatomical structure and hemodynamics, CALVMMFs often result in no obvious symptoms and signs. Most patients are diagnosed by coronary angiography; however, as a routine noninvasive screening method, Doppler echocardiography is a potential first-choice diagnostic technique for patients with CALVMMFs. Although satisfactory results of CALVMMF closure are difficult to achieve, the clinical symptoms of these patients are not obvious, and drug therapy has a clear therapeutic effect on most patients. We herein introduce seven cases of CALVMMFs confirmed by our hospital and briefly review the related literature.
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Affiliation(s)
| | - Zhihuan Zeng
- Zhihuan Zeng, Cardiovascular Department,
The First Affiliated Hospital of Guangdong Pharmaceutical University, No. 19
Nonglinxia Road, Guangzhou, Guangdong 510080, People’s Republic of China.
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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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Surgical Strategy for Huge Right Coronary Artery Aneurysm Combined with Left Ventricular Fistula. Case Rep Cardiol 2021; 2021:8438640. [PMID: 34659837 PMCID: PMC8516521 DOI: 10.1155/2021/8438640] [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: 07/24/2021] [Accepted: 09/13/2021] [Indexed: 11/24/2022] Open
Abstract
Coronary artery aneurysms combined with left ventricular fistulas are rare; coronary revascularization strategy after coronary artery aneurysm resection is complex in such cases. We report the surgical repair of a giant right coronary artery aneurysm with a fistula in the left ventricle in a 79-year-old woman diagnosed with an aneurysm 50 mm in diameter. Surgical repair included resection of the coronary artery aneurysm, coronary artery bypass grafting to the posterior descending artery, and isolation of reconstructed right coronary circulation from the fistula. The postoperative course was uneventful; postoperative coronary angiography revealed a patent bypass graft unconnected to the left ventricle.
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Coronary Artery Fistulas: Indications, Techniques, Outcomes, and Complications of Transcatheter Fistula Closure. JACC Cardiovasc Interv 2021; 14:1393-1406. [PMID: 34238550 DOI: 10.1016/j.jcin.2021.02.044] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/02/2021] [Accepted: 02/16/2021] [Indexed: 11/20/2022]
Abstract
Coronary artery fistulas (CAFs) are rare coronary anomalies that are usually diagnosed incidentally with cardiac imaging. Small CAFs are generally asymptomatic and can close over time, while some untreated medium or large CAFs can enlarge, leading to clinical sequelae such as cardiac chamber enlargement or myocardial ischemia. With the advancement of transcatheter equipment and techniques, CAFs have been increasingly closed using a percutaneous approach. However, the procedure is not free of limitations given the risk for myocardial infarction, device embolization, and fistula recanalization. In this review, the authors illustrate the contemporary procedural considerations, techniques, and outcomes of transcatheter CAF closure.
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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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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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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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Qarajeh R, Qureini A, Thompson RC, Saeed IM. Acute Heart Failure From Coronary Cameral Fistula. JACC Case Rep 2020; 2:2368-2371.e1. [PMID: 34317173 PMCID: PMC8304534 DOI: 10.1016/j.jaccas.2020.09.034] [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: 04/28/2020] [Revised: 09/09/2020] [Accepted: 09/22/2020] [Indexed: 11/06/2022]
Abstract
A 40-year-old African American woman presented with dyspnea, orthopnea, weight gain, and ankle edema. She was admitted for acute decompensated heart failure. Coronary angiography revealed coronary cameral fistula. We used multiple imaging modalities to confirm the fistula’s pathway. Her left ventricular systolic function improved after repair of coronary cameral fistula. (Level of Difficulty: Beginner.)
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15
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Wang X, Pang C, Liu X, Wang S, Zhang Z, Chen J, Zhuang J, Zhou C. Congenital coronary artery fistula in pediatric patients: transcatheter versus surgical closure. BMC Cardiovasc Disord 2020; 20:484. [PMID: 33198628 PMCID: PMC7670810 DOI: 10.1186/s12872-020-01769-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/05/2020] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Transcatheter closure (TCC) and surgical closure (SC) are the two main approaches for congenital coronary artery fistula (CCAF), but data on the comparisons of the efficacy and safety of these two approaches are limited. METHODS We retrospectively reviewed pediatric patients with CCAF in Guangdong Cardiovascular Institute between January 2002 and December 2017. Patients who were qualified into our criteria were included into final analysis. The rate of successful closure and complications during hospitalization and at follow-up were compared between SC and TCC groups. RESULTS In total, 121 pediatric patients (male, n = 69; female, n = 52) with CCAF were divided to TCC (n = 63) and SC groups (n = 58) according to the indications. The mean age was 5.3 ± 1.4 years. The baseline characteristics of these two groups were similar except for the fistula anatomic feature. After adjusted for the fistula anatomy, compared to SC, TCC was associated with higher risk of major complications (p = 0.013). Proportions of patients requiring blood transfusion and intra-operative blood loss were higher in SC versus TCC groups, as were longer duration of hospital and ICU stay during hospitalization. In contrast, myocardial ischemia (10.2% vs 0.0%, p = 0.028), residual shunts (16.9% vs 3.6%, p = 0.045) and new-onset moderate-to-severe valve regurgitation (11.9% vs 0.0%, p = 0.013) were higher in TCC group versus SC groups during follow-up. CONCLUSIONS TCC has less invasive and faster recovery. However, SC had a higher successful rate and lower risk of major complications in pediatric patients.
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Affiliation(s)
- Xiaoyong Wang
- The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Department of Cardiovascular Surgery, Guangdong Provincial Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510000, China
| | - Chengcheng Pang
- Department of Pediatric Cardiology, Guangdong Provincial Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Provincial Academy of Medicine, Guangzhou, China
| | - Xiaobing Liu
- Department of Cardiovascular Surgery, Guangdong Provincial Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510000, China
| | - Shushui Wang
- Department of Pediatric Cardiology, Guangdong Provincial Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Provincial Academy of Medicine, Guangzhou, China
| | - Zhiwei Zhang
- Department of Pediatric Cardiology, Guangdong Provincial Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Provincial Academy of Medicine, Guangzhou, China
| | - Jimei Chen
- Department of Cardiovascular Surgery, Guangdong Provincial Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510000, China
| | - Jian Zhuang
- Department of Cardiovascular Surgery, Guangdong Provincial Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510000, China
| | - Chengbin Zhou
- Department of Cardiovascular Surgery, Guangdong Provincial Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510000, China.
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Long-Term Follow-Up of Pediatric Patients After Congenital Coronary Artery Fistula Closure. Pediatr Cardiol 2020; 41:1346-1353. [PMID: 32474739 DOI: 10.1007/s00246-020-02379-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 05/22/2020] [Indexed: 10/24/2022]
Abstract
The surgical closure of congenital coronary artery fistulas (CAF) is associated with excellent immediate outcomes. Few studies have investigated the long-term prognosis in patients who have undergone surgery for the closure of CAF or differentiated among types of CAF or types of surgical procedures. In this study, we performed clinical examinations and computed tomography angiography (CTA) to characterize outcomes after CAF closure in pediatric patients. The medical records of 79 pediatric patients who underwent surgical closure of CAF were retrospectively reviewed. The median age of the patients included in the study at the time of surgery was 3.4 years (range 0.2 to 15.3 years). The patients had been followed up for 11 years (range 1 to 17 years) with electrocardiography, echocardiography, and coronary CTA. There were 67 medium-to-large CAF and 12 small CAF. Twenty-six (32.9%) CAF arose from the branch coronary artery (proximal type); the others arose from the parent coronary artery (distal type). The surgical procedure included endocardial closure in 16 cases, epicardial distal ligation in 51 cases, epicardial proximal and distal ligation in 12 cases. There was no instance of perioperative death among the cases included in the study. Twenty-eight patients were treated with antiplatelet medication postoperatively. No patient required re-operation during the follow-up period. Coronary thrombi were detected in 27 patients (34.2%). There was no instance of myocardial ischemia related to thrombosis. Among the patients with thrombosis, 26 had medium-to-large CAF (96.3%), and 23 had distal-type CAF (85.2%). Average age at surgery was higher among the patients with thrombosis than among the patients without thrombosis (7.4 years vs. 3.3 years, t = 5.509, P = 0.000). Among the patients with distal-type CAF, thrombosis was more common among the patients treated with ligation than treated with endocardial closure (41.5% vs. 16.7%, χ2 = 3.742, P = 0.043). There was no difference in risk for thrombosis between the patients who did vs. did not receive antiplatelet therapy (P = 0.436). The most common complication after CAF closure was thrombosis. Increased risk for thrombosis was associated with large fistulae, distal-type CAF, and older age at presentation. Antiplatelet treatment did not appear to decrease the risk of thrombosis. Among patients with distal-type CAF, risk for thrombosis was lower among patients treated with endocardial closure, compared with patients treated with epicardial ligation.
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17
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Kubota S, Hara H, Yamamoto M, Hiroi Y. Percutaneous Coil Embolization of Confluent Bilateral Coronary Artery Fistulas. JACC Case Rep 2020; 2:991-995. [PMID: 34317400 PMCID: PMC8302086 DOI: 10.1016/j.jaccas.2020.04.034] [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: 02/13/2020] [Revised: 04/03/2020] [Accepted: 04/13/2020] [Indexed: 10/29/2022]
Abstract
A 52-year-old woman presented with a continuous heart murmur at an annual health examination. Coronary computed tomography angiography showed confluent coronary artery fistulas meeting to form a large aneurysm fistulizing to the pulmonary artery. Percutaneous coil embolization was performed, resulting in the disappearance of the coronary artery fistulas and aneurysms. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Shuji Kubota
- Department of Cardiology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hisao Hara
- Department of Cardiology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masaya Yamamoto
- Department of Cardiology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yukio Hiroi
- Department of Cardiology, National Center for Global Health and Medicine, Tokyo, Japan
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18
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Chen MA. Noncompaction cardiomyopathy and multiple coronary-cameral fistulae in an octogenarian. J Cardiol Cases 2020; 21:227-230. [PMID: 32547659 DOI: 10.1016/j.jccase.2020.02.003] [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: 10/30/2019] [Revised: 12/17/2019] [Accepted: 02/20/2020] [Indexed: 10/24/2022] Open
Abstract
An 85-year-old man was admitted to the emergency department with chest pain. His electrocardiogram showed a right bundle branch block as well as increased voltages suggesting left ventricular hypertrophy and t-wave inversions consistent with a strain pattern (versus ischemia). He underwent echocardiography which showed regional noncompaction and associated hypokinesis. These findings led to coronary angiography which revealed multiple coronary-cameral fistulae involving all three coronary arteries. He was initially treated for acute coronary syndrome but after his diagnostic procedures this was narrowed to a beta blocker, to reduce myocardial oxygen demand, and an angiotensin-converting enzyme inhibitor due to the cardiomyopathy. Although the fistulae may have caused the patient's chest pain, intervention was not possible due to the diffuse nature of the fistulae. He did well in follow-up without the development of heart failure symptoms or continued angina. <Learning objective: Noncompaction cardiomyopathy and coronary cameral fistulae are two rare disorders that have even more rarely been described in a single patient. They may be a part of a spectrum of a single disease that results from arrest of the normal sequence of embryologic development of the heart. The management of the two conditions includes aspects of standard heart failure care as well as medical and possibly interventional therapy for coronary ischemia (angina) related to fistulae.>.
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Affiliation(s)
- Michael A Chen
- Harborview Medical Center, University of Washington School of Medicine, 325 9 Avenue, Box 359748, Seattle, WA 98104, USA
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19
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Harada Y, Mori A, Mori M, Yoshimoto T. Giant Aneurysm of Coronary Artery Fistula Successfully Treated by Surgical Repair. Cureus 2020; 12:e7430. [PMID: 32351810 PMCID: PMC7186111 DOI: 10.7759/cureus.7430] [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] [Indexed: 11/18/2022] Open
Abstract
An asymptomatic 65-year-old woman was identified with an oversized round-shaped hypoechoic lesion (62 mm in diameter) between right and left atria by echocardiogram. A contrast-enhanced 320-slice multidetector computed tomography demonstrated a giant aneurysmatic fistula branched from the left main coronary trunk towards right atrium. The patient underwent an elective surgical repair. The aneurysm was resected, followed by coronary artery bypass graft surgery using bilateral internal thoracic arteries. The surgery was successful, and the patient enjoys normal life without any symptoms for 15 months.
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Affiliation(s)
- Yuko Harada
- Internal Medicine, Yamato Tokushukai Hospital, Yamato, JPN.,Internal Medicine, Harada Naika Clinic, Kawasaki, JPN
| | - Atsuo Mori
- Cardiovascular Surgery, Kawasaki Municipal Hospital, Kawasaki, JPN
| | - Mitsuharu Mori
- Cardiovascular Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, JPN
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20
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Liu H, Li X, Song H, Wei W. Anesthesia Management for a Patient with Coronary Artery Fistula and Huge Coronary Aneurysm Undergoing Off-Pump Surgery. J Cardiothorac Vasc Anesth 2020; 34:1885-1889. [PMID: 32178951 DOI: 10.1053/j.jvca.2020.02.002] [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] [Received: 09/03/2019] [Revised: 01/30/2020] [Accepted: 02/02/2020] [Indexed: 02/08/2023]
Affiliation(s)
- Haibei Liu
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xiang Li
- Department of Cardiac Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Haibo Song
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Wei Wei
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
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21
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El‐Sabawi B, Al‐Hijji MA, Eleid MF, Cabalka AK, Ammash NM, Dearani JA, Bjarnason H, Holmes DR, Rihal CS. Transcatheter closure of coronary artery fistula: A 21‐year experience. Catheter Cardiovasc Interv 2020; 96:311-319. [DOI: 10.1002/ccd.28721] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 12/31/2019] [Indexed: 01/08/2023]
Affiliation(s)
| | | | - Mackram F. Eleid
- Department of Cardiovascular Diseases Mayo Clinic Rochester Minnesota
| | | | - Naser M. Ammash
- Department of Cardiovascular Diseases Mayo Clinic Rochester Minnesota
| | - Joseph A. Dearani
- Department of Cardiovascular Surgery Mayo Clinic Rochester Minnesota
| | | | - David R. Holmes
- Department of Cardiovascular Diseases Mayo Clinic Rochester Minnesota
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23
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Casavecchia G, Zicchino S, Gravina M, Martone A, Cuculo A, Macarini L, Di Biase M, Brunetti ND. Dual Coronary-Pulmonary Fistula Firstly Found at Routine Doppler Echocardiogram. J Cardiovasc Echogr 2019; 29:23-25. [PMID: 31008035 PMCID: PMC6450228 DOI: 10.4103/jcecho.jcecho_47_18] [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] [Indexed: 11/13/2022] Open
Abstract
Congenital coronary-pulmonary fistulas (CPFs) are defined as an abnormal direct communication between one or more coronary arteries, with a cardiac or thoracic structure bypassing the capillary network. We report the case of a 73-year-old male, with a history of hypertension, asymptomatic for angina and dyspnea, who was referred for routine clinical control. Echocardiogram unexpectedly showed the presence of diastolic flow from the pulmonary trunk in parasternal short-axis view. Pulsed-wave Doppler confirmed the presence of diastolic flow and displayed the typical coronary flow pattern. Coronary angiography hence showed the presence of dual CPFs originating from the second segment of the left anterior descending coronary and the right coronary arteries. Careful routine Doppler echocardiograph examination may raise the suspicion of CPF in case of otherwise unexplained symptoms and may represent a simple, easy, repeatable tool for the first suspected diagnosis and follow-up of CPFs.
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Affiliation(s)
| | | | - Matteo Gravina
- Cardiology Department, University of Foggia, Foggia, Italy
| | | | - Andrea Cuculo
- Cardiology Department, University of Foggia, Foggia, Italy
| | - Luca Macarini
- Cardiology Department, University of Foggia, Foggia, Italy
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24
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Sakai M, Mori K, Hoshiai S, Kikuchi S, Hoshi T, Sato A, Ohtani M, Minami M. Successful transarterial embolization of coronary artery fistula with ruptured aneurysm: A case report. Radiol Case Rep 2018; 14:126-128. [PMID: 30386452 PMCID: PMC6205050 DOI: 10.1016/j.radcr.2018.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 10/14/2018] [Indexed: 01/27/2023] Open
Abstract
We report a case of a coronary artery fistula (CAF) with ruptured aneurysm treated using transarterial embolization (TAE) alone. The ruptured aneurysm caused cardiac tamponade, and it was isolated by embolizing its afferent and efferent vessels using detachable coils. To our knowledge, this is the first case report of successful TAE for a CAF with ruptured aneurysm. We believe that if the patient condition is stable and the CAF is anatomically simple, TAE can be a less-invasive alternative to surgery.
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Affiliation(s)
- Masafumi Sakai
- Department of Diagnostic & Interventional Radiology, University of Tsukuba Hospital, Amakubo 2-1-1, Tsukuba, Ibaraki 305-8576, Japan
| | - Kensaku Mori
- Department of Radiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Sodai Hoshiai
- Department of Radiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Shunsuke Kikuchi
- Department of Diagnostic & Interventional Radiology, University of Tsukuba Hospital, Amakubo 2-1-1, Tsukuba, Ibaraki 305-8576, Japan
| | - Tomoya Hoshi
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Akira Sato
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Masafumi Ohtani
- Department of Cardiology, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Manabu Minami
- Department of Radiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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25
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Sunkara A, Chebrolu LH, Chang SM, Barker C. Coronary Artery Fistula. Methodist Debakey Cardiovasc J 2018; 13:78-80. [PMID: 28740588 DOI: 10.14797/mdcj-13-2-78] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Coronary artery fistulae are rare abnormalities of the coronary arteries that are usually discovered incidentally on coronary angiogram. Most patients remain asymptomatic, and significant hemodynamic consequences are rarely observed. The following report describes the case of a patient presenting with symptoms of congestive cardiac failure due to multiple coronary artery fistulae.
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26
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Thind GS, Agrawal Y, Kalavakunta JK, Lapenna R. A case of congenital coronary-pulmonary fistulas presenting as spontaneous mediastinal haemorrhage. BMJ Case Rep 2017; 2017:bcr-2017-221282. [PMID: 28724599 DOI: 10.1136/bcr-2017-221282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Coronary artery fistulas are rare anomalous vascular connections between coronary arteries and a cardiac chamber or a central vessel, without an intervening capillary bed. Coronary-pulmonary fistulas are a distinct subset of coronary artery fistulas. We present the case of a previously healthy 63-year-old-man who presented with chest pain and was found to have mediastinal haemorrhage. Upon further investigations, he was found to have multiple coronary-pulmonary fistulas with pseudoaneurysm formation in three of the fistulas. Two of these pseudoaneurysms showed inflammatory changes indicative of recent bleed. These were determined to be the source of the mediastinal bleeding and patient’s initial presentation. The patient was managed medically after obtaining multiple expert opinions from various institutions.
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Affiliation(s)
- Guramrinder Singh Thind
- Department of Internal Medicine, Western Michigan University School of Medicine, Kalamazoo, Michigan, USA
| | - Yashwant Agrawal
- Department of Internal Medicine, Western Michigan University School of Medicine, Kalamazoo, Michigan, USA
| | | | - Robert Lapenna
- Borgess Medical Center/Michigan State University, Kalamazoo, Michigan, USA
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27
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Mishra RC, Barik R, Patnaik AN. Infective Endocarditis of the Left Main to Right Atrial Coronary Cameral Fistula. J Cardiovasc Echogr 2017; 26:123-126. [PMID: 28465978 PMCID: PMC5224661 DOI: 10.4103/2211-4122.192178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
A 7-year-old female child presented with pyrexia of unknown origin. She had received an empirical regimen of antibiotic for possible endocarditis. Evaluation included multiple imaging supports and blood culture. She had left main coronary artery to right atrium coronary cameral fistula, restricted patent ductus arteriosus, vegetation at the right atrial exit of fistula and negative blood culture. Ongoing fever more than 2 weeks, oscillating vegetation in the echo and histopathological evidence of healing vegetation suggested definite diagnosis of infective endocarditis. She was treated successfully by surgical closure of fistula from the right atrial approach. Device closure in this case would have resulted in a large residual cul-de-sac with or without tiny residual high-velocity jets, either being a threat for future enlargement, rupture of the residual aneurysmal sac, thromboembolism, prolonged anticoagulation, and infective endocarditis.
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Affiliation(s)
- Ramesh Chandra Mishra
- Department of Cardiothoracic Surgery, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Ramachandra Barik
- Department of Cardiology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Amar Narayana Patnaik
- Department of Cardiology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
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28
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Characteristics of Coronary Artery to Pulmonary Artery Fistula on Coronary Computed Tomography Angiography. J Comput Assist Tomogr 2017; 40:398-401. [PMID: 26854415 DOI: 10.1097/rct.0000000000000370] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the characteristics of coronary artery-to-pulmonary artery fistula (CPAF) found by coronary computed tomography (CT) angiography. METHODS Among 10,121 cases of coronary CT angiography performed for 7 years, we found 32 cases of CPAF. We retrospectively evaluated the demographics, clinical symptoms, and anatomical characteristics such as the origin, number of origins, course, opening site of the fistula, and the presence of aneurysmal changes (defined as dilatation 1.5 times the diameter of the origin). We also categorized the fistula openings according to size compared with that of the proximal left anterior descending coronary artery. RESULTS The patients were 14 men and 18 women with a mean (range) age of 56.5 (34-86) years. Nineteen patients had no related symptoms, and the other 13 patients had symptoms such as angina, chest discomfort, palpitations, or shoulder pain. Among these patients, 2 patients were diagnosed with coronary artery disease. The origins of CPAF were single (n = 15, 46.9%) or multiple (n = 17, 53.1%). The CPAFs arose most commonly from the conus branch of the right coronary artery (n = 20, 62.5%) and proximal left anterior descending (n = 17, 53.1%). All CPAFs coursed anteriorly to the main pulmonary artery and drained into the anterolateral aspect. Twenty-five patients (78.1%) exhibited aneurysmal changes. The openings were small in 13 (40.6%), medium in 13 (40.6%), and large in 6 (18.8%) patients. CONCLUSIONS More than half of patients with CPAF had no related symptoms. Coronary artery-to-pulmonary artery fistula may have a single origin or multiple origins. All of the CPAFs coursed anteriorly to the main pulmonary artery and drained into the anterolateral aspect; the CPAFs identified here frequently exhibited aneurysmal changes.
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29
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Rodriguez JD. Incidental Finding of a Right Coronary Artery to Coronary Sinus Fistula in an Adult Transthoracic Echocardiogram. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2016. [DOI: 10.1177/8756479316664339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Congenital coronary artery fistula (CAF) is a rare anomaly of the heart presenting in 0.002% of the general population. This case study presents an adult patient with an undiagnosed heart murmur and symptoms of chest pain, fatigue, and lightheadedness that demonstrated an incidental finding of CAF diagnosed by transthoracic echocardiography. Transthoracic echocardiography revealed an aneurysmal, tortuous right coronary artery terminating in a dilated coronary sinus. Sonographic findings were compared with angiography and computed tomography. This study highlights the potential of transthoracic echocardiography to assess heart structure and physiology and detect a CAF.
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30
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Said SAM. Characteristics of Congenital Coronary Artery Fistulas Complicated with Infective Endocarditis: Analysis of 25 Reported Cases. CONGENIT HEART DIS 2016; 11:756-765. [DOI: 10.1111/chd.12392] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2016] [Indexed: 02/06/2023]
Affiliation(s)
- Salah AM Said
- Department of Cardiology; Hospital Group Twente; Hengelo The Netherlands
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31
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Wen B, Yang J, Jiao Z, Fu G, Zhao W. Right coronary artery fistula misdiagnosed as right atrial cardiac myxoma: A case report. Oncol Lett 2016; 11:3715-3718. [PMID: 27284376 DOI: 10.3892/ol.2016.4457] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 01/19/2016] [Indexed: 12/25/2022] Open
Abstract
The current study describes a case of right coronary artery fistula (CAF) misdiagnosed as right atrial myxoma (RAM). A 33-year-old man presented with a 13-year history of intermittent chest pain, and aggravation for 3 days. Echocardiography revealed an occupying lesion in the right atrium producing a partial dynamic tricuspid obstruction. The initial diagnosis was RAM, which causes partial right ventricular inflow tract obstruction. During cardiopulmonary bypass surgery, a giant mass was detected in the anterior wall of the right ventricle and an abnormal vascular fistula was observed at the bottom of the mass. Successful excision of the mass and closure of the fistula completely relieved the patient's presenting symptoms. The disease was subsequently diagnosed as right CAF draining to the myocardial void. The surgical management and misdiagnosis of the case are discussed herein.
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Affiliation(s)
- Bing Wen
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Junya Yang
- Department of Dermatology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Zhouyang Jiao
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Guowei Fu
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Wenzeng Zhao
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
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32
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Alvarado T, Pozo E, Viliani D, Zabala I, Benedicto A, Olivera MJ, Jiménez-Borreguero LJ, Alfonso F. Coronary fistula as an arteriovenous malformation behind the left atrium. Untightening the tangle with cardiac CT. Int J Cardiol 2016; 207:177-9. [DOI: 10.1016/j.ijcard.2016.01.024] [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: 12/06/2015] [Accepted: 01/02/2016] [Indexed: 10/22/2022]
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33
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Tiritilli A, Iaria P, Viard P, Sayah S, Benali T, Detienne JP, Martis S, Tchatchum F, Aouate P. [Coronary artery fistulas, a current problem: Clinical and therapeutic considerations]. Ann Cardiol Angeiol (Paris) 2016; 65:31-37. [PMID: 23806865 DOI: 10.1016/j.ancard.2013.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 04/01/2013] [Indexed: 06/02/2023]
Abstract
The coronary fistula is a link between one or more of the coronary arteries and cardiac cavity or great vessel. The exact occurrence is unknown. The majority of these fistulas are congenital in origin. However, they may occasionally be detected after cardiac surgery. For a long time, fistulas are asymptomatic, especially if they are small; the frequency of the symptoms and especially the complications rise with age. The potential complications are: cardiac failure, endocarditis, endarteritis, atrial fibrillation, ventricular arrhythmias, rupture, and thrombosis. The main differential diagnosis is patent arterial duct, while other congenital arteriovenous shunts need to be excluded. Even though echocardiography Doppler can help to differentiate shunts, the coronary angiography remains the main diagnostic tool for the description of the anatomy. For a long time, the surgery was the only therapeutic means, up till now, percutaneous occlusion is the first line therapy of coronary fistulas and that the different devices can be tailored to meet different anatomic and functional characteristics.
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Affiliation(s)
- A Tiritilli
- Service de cardiologie, centre hospitalier Laennec, 60100 Creil, France.
| | - P Iaria
- Service de cardiologie, centre hospitalier Laennec, 60100 Creil, France
| | - P Viard
- Service de cardiologie, centre hospitalier Laennec, 60100 Creil, France
| | - S Sayah
- Service de cardiologie, centre hospitalier Laennec, 60100 Creil, France
| | - T Benali
- Service de cardiologie, centre hospitalier Laennec, 60100 Creil, France
| | - J-P Detienne
- Service de cardiologie, centre hospitalier Laennec, 60100 Creil, France
| | - S Martis
- Service de cardiologie, centre hospitalier Laennec, 60100 Creil, France
| | - F Tchatchum
- Service de cardiologie, centre hospitalier Laennec, 60100 Creil, France
| | - P Aouate
- Service de cardiologie, centre hospitalier Laennec, 60100 Creil, France
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34
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Closure of Isolated Congenital Coronary Artery Fistula: Long-Term Outcomes and Rate of Re-intervention. Pediatr Cardiol 2015; 36:1728-34. [PMID: 26111747 DOI: 10.1007/s00246-015-1224-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 06/16/2015] [Indexed: 10/23/2022]
Abstract
Long-term outcome after closure of isolated congenital coronary artery fistula (ICCAF) is poorly documented. To assess late outcome after ICCAF closure, a 1983-2013 retrospective study included all patients who attempted an ICCAF closure and whose follow-up was ≥1 year. ICCAF was diagnosed in 23 patients [median age 6.9 years (0.1-70.5 years), 13 children]. ICCAF was symptomatic in 12 patients (52.2 %). First intervention was either a transcatheter embolization (n = 19 patients, 82.6 %) or a surgical ligation (n = 4 patients, 17.4 %). After a follow-up of 9.0 years (2.8-33.5), neither death nor late ischemic event occurred but one patient was transplanted, because of postoperative myocardial infarction. Late ICCAF recanalization occurred in eight patients, leading to successful embolization of the shunt in all patients after a delay of 9.8 years (5.7-13.8 years) from the first intervention. Re-intervention occurred later in children (p = 0.0027), with a 50 and 37.5 % freedom from re-intervention in adults compared to a 100 and 89.0 % in children, respectively, at 1 and 6 years of follow-up. At last follow-up, coronary artery diameter had decreased from a mean z score of 12.0 ± 7.7 to a mean z score of 6.0 ± 6.0 (p = 0.002). Long-term outcome after ICCAF closure is excellent, with neither death nor late ischemic event, and a significant decrease in coronary artery diameter with time. Late follow-up is of paramount importance, as one-third of patients will require a re-intervention for late shunt recanalization.
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Progressive aneurysmal dilation of coronary arterial fistula after transcatheter closure: successfully treated by a second occlusion device. Cardiol Young 2015; 25:813-7. [PMID: 25075952 DOI: 10.1017/s1047951114001310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We report on a 6-year-old boy with a huge right coronary artery to the right ventricle fistula, who had previously been treated by device closure at the right ventricular exit point. However, 3 years later, the right coronary artery aneurysm showed progressively dilation and compressed the right ventricle. To prevent further complications related to the aneurysm, the proximal part of the aneurysm was successfully occluded by a vascular plug.
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Said SAM, Nijhuis RLG, Akker JWOD, Takechi M, Slart RHJA, Bos JS, Hoorntje CR, Houwelingen KGV, Bakker-de Boo M, Braam RL, Vet TMWJ. Unilateral and multilateral congenital coronary-pulmonary fistulas in adults: clinical presentation, diagnostic modalities, and management with a brief review of the literature. Clin Cardiol 2014; 37:536-45. [PMID: 25196980 DOI: 10.1002/clc.22297] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Revised: 04/18/2014] [Accepted: 04/20/2014] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Congenital coronary-pulmonary fistulas (CPFs) are commonly unilateral, but bilateral and multilateral fistulas may occur. In multilateral CPFs, the value of a multidetector computed tomography (MDCT) imaging technique as an adjuvant to coronary angiography (CAG) is eminent. The purpose of this study was to describe the clinical presentation, diagnostic modalities, and management of coincidentally detected congenital CPFs. HYPOTHESIS Unilateral and multilateral coronary-pulmonary fistulas are increasingly detected due to the wide speard application of multidetector computed tomography which might be a supplementary or replacing to conventional coronary angiography. METHODS We evaluated 14 adult patients with congenital coronary artery fistulas (CAFs) who were identified from several Dutch cardiology departments. RESULTS Fourteen adult patients (5 female and 9 male), with a mean age of 57.5 years (range, 24-80 years) had the following abnormal findings: audible systolic cardiac murmur (n = 4), chronic atrial fibrillation (n = 2), nonsustained ventricular tachycardia (n = 1), and cardiomegaly on chest x-ray (n = 2). Echocardiography revealed normal findings with trivial valvular abnormalities (n = 9), depressed left ventricle systolic function (n = 3), and severe mitral regurgitation and atrial dilatation (n = 2). The findings in the rest of the patients were unremarkable. CAG and MDCT were used as a diagnostic imaging techniques either alone (CAG, n = 6; MDCT, n = 1) or in combination (n = 7). Single modality and multimodality diagnostic methods revealed 22 fistulas including CPFs (n = 15), coronary cameral fistulas terminating into the right (n = 2) and the left atrium (n = 1), and systemic-pulmonary fistulas (n = 4). Of all of the fistulas, 10 were unilateral, 6 were bilateral, and 6 was hexalateral. (13) N-ammonia positron emission tomography-computed tomography was performed in 3 patients revealing decreased myocardial perfusion reserve. CONCLUSIONS CAG remains the gold standard for detection of CPFs. An adjuvant technique using MDCT provides full anatomical details of the fistulas.
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Affiliation(s)
- Salah A M Said
- Department of Cardiology, Hospital Group Twente, Hengelo, the Netherlands
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Multiple multilateral coronary-cameral fistulae in a patient with minor cardiac venous system. Case Rep Cardiol 2014; 2014:754703. [PMID: 24826312 PMCID: PMC4008345 DOI: 10.1155/2014/754703] [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: 11/13/2013] [Accepted: 12/29/2013] [Indexed: 11/17/2022] Open
Abstract
A 40-year-old man was hospitalized in the coronary care unit with chest pain and abnormal electrocardiogram. Twenty days earlier, the patient underwent laparoscopic gallbladder surgery. Due to chest pain and ischemic ECG changes, patient was subjected to coronary angiography. The selective coronary angiography revealed multiple multilateral fistulae arising from the left anterior descending artery, circumflex artery, and the right coronary artery draining to the left ventricle. Multislice computed tomography showed hypoplastic coronary sinus and minor cardiac venous system.
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Young A, Cheng R, Wei J, Esmailian F, Currier J, Azarbal B. Prevalence of coronary artery fistulae after cardiac surgery. Comparison between coronary artery bypass grafting, valve surgery, and orthotopic heart transplantation. Herz 2014; 40 Suppl 1:51-5. [PMID: 24577076 DOI: 10.1007/s00059-014-4053-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 12/12/2013] [Accepted: 01/01/2014] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Coronary artery fistulae (CAF) are anomalous connections from a coronary artery to a recipient pulmonary vessel or cardiac chamber, and are reported in 0.2 % of the general population. The prevalence of CAF in the modern orthotopic heart transplant (OHT) population has been demonstrated to be significantly higher. The mechanism is unknown but one proposal is endothelial and vascular growth factor activation from injury. We hypothesize an incremental increase in CAF prevalence with the complexity of surgery, such that patients who have undergone OHT surgery would have an increased prevalence of CAF, as compared with patients who have undergone coronary artery bypass (CABG) surgery with valve surgery and as compared with patients who have undergone CABG surgery only. PATIENTS AND METHODS Consecutive angiograms of 481 patients after CABG surgery and 432 patients after OHT were reviewed. Patients who had previous valve surgery in addition to CABG were identified. Presence of CAF was determined. The chi-squared test was used for statistical analysis. RESULTS In all, 436 patients had CABG only (group A), 45 patients had CABG with valve surgery (group B), and 432 patients had OHT (group C). The mean age of patients at the time of surgery for group A, B, and C was 59.0, 66.1, and 55.3 years, respectively. The percentage of male patients was 78.4, 77.8, and 77.1 %, respectively. We found 10 patients (2.3 %) with CAF in group A compared with 4 patients (8.9 %) in group B, and 88 patients (20.4 %) in group C, which was statistically significant (p < 0.001). All CAF were small, were not associated with hemodynamic compromise or significant adverse events, and were managed conservatively. CONCLUSION There is an increased prevalence of CAF formation both after CABG and OHT compared with the general population. The higher prevalence of CAF in patients who additionally underwent valve surgery or who underwent OHT may be attributed to differences in surgical complexity. The increased prevalence of CAF formation after OHT compared with CABG should be further investigated.
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Affiliation(s)
- A Young
- Cedars-Sinai Heart Institute, 8536 Wilshire Blvd 302, 90211, Los Angeles, California, USA
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A case of fistulous tracts from all coronary arteries to pulmonary trunk, right ventricle, left atrium, bronchial arteries and aorta, co-existing fistulas between bronchial arteries and pulmonary arteries. Int J Cardiol 2014; 172:e62-5. [DOI: 10.1016/j.ijcard.2013.12.053] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 12/21/2013] [Indexed: 01/18/2023]
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Surgical Management of Left Circumflex Coronary Artery Fistula: A 25-Year Single-Center Experience in 29 Patients. Ann Thorac Surg 2014; 97:530-6. [DOI: 10.1016/j.athoracsur.2013.09.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 08/30/2013] [Accepted: 09/04/2013] [Indexed: 11/20/2022]
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Harada Y, Mori A, Abiko T, Saka S, Shinagawa T, Yoshimoto T. Cardiac tamponade due to the rupture of the coronary artery fistula. Cardiovasc Diagn Ther 2013; 3:105-7. [PMID: 24282752 DOI: 10.3978/j.issn.2223-3652.2013.03.01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Accepted: 03/05/2013] [Indexed: 11/14/2022]
Affiliation(s)
- Yuko Harada
- Department of Cardiology, Kawasaki Municipal Ida Hospital, Japan
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[Acquired coronary-cameral fistula complicated by a ventricular pseudoaneurysm]. Ann Cardiol Angeiol (Paris) 2013; 62:442-5. [PMID: 24119773 DOI: 10.1016/j.ancard.2013.08.001] [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: 10/18/2011] [Accepted: 08/12/2013] [Indexed: 11/20/2022]
Abstract
Coronary-cameral fistulas are usually congenital, rarely acquired; the complication of this anomaly with ventricular pseudoaneurysm is exceptional. We report a new case of acquired coronary-cameral fistula, occurred in a patient who had received a bypass graft and who had suffered from angina 1 year after the surgery. On computed tomography coronary angiography, the fistula seems to communicate the first diagonal to a left ventricle pseudoaneurysm. Embolization of the fistula and filling of the pseudoaneurysm by neurocoil were successfully performed. The clinical and angiographic control after 3 months showed symptoms improvement and absence of recanalization of the fistula.
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Said SAM, Schiphorst RHM, Derksen R, Wagenaar L. Coronary-cameral fistulas in adults (first of two parts). World J Cardiol 2013; 5:329-336. [PMID: 24109496 PMCID: PMC3783985 DOI: 10.4330/wjc.v5.i9.329] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 07/05/2013] [Accepted: 08/29/2013] [Indexed: 02/06/2023] Open
Abstract
This is a case series and review of the literature adding 11 new cases. Coronary-cameral fistulas (CCFs) are infrequent anomalies which are in general co-incidentally found during diagnostic coronary angiography (CAG). To delineate the characteristics of congenital and acquired CCFs in adults, we performed a PubMed search for papers dealing with congenital or acquired CCFs in adults. Publications on coronary-vascular fistulas or paediatric subjects were not included. From the world literature, a total of 243 adult patients were identified who had congenital (65%) or acquired (35%) CCFs. In this review, which is part one of a two-part series on CCFs, we describe and discuss the congenital fistulas, give an overview on the published literature and report details of our own series of 11 patients with MMFs and solitary macro CCFs. Of the congenital group, 85% were small or large solitary macro CCFs (cut-off 1.5 mm) and 15% were coronary artery-ventricular multiple micro-fistulas (MMFs). Apical hypertrophic cardiomyopathy was reported in some of the reviewed subjects with MMFs (3/24 = 13%) but not was seen in our own series. Conservative medical management was generally the treatment of choice in congenital MMFs; prophylactic implantable cardioverter defibrillators (ICD) were implanted in 2/24 (8%) of subjects, especially when extensive micro-fistulisations were involved. None of the patients of our own series required an ICD, as the MMFs were of limited size. Congenital or acquired CCFs in adults are infrequent anomalies having a wide spectrum of clinical presentation may varies from asymptomatic to severely devastating states requiring different treatment modalities.
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Frequency of coronary artery fistulae is increased after orthotopic heart transplantation. J Heart Lung Transplant 2013; 32:744-6. [PMID: 23664527 DOI: 10.1016/j.healun.2013.04.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 04/05/2013] [Accepted: 04/09/2013] [Indexed: 01/30/2023] Open
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Right-sided scimitar syndrome in a patient with a single aortic trunk and coronary-cameral venous fistula. Rev Port Cardiol 2013; 32:63-6. [DOI: 10.1016/j.repc.2012.05.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 05/06/2012] [Accepted: 05/09/2012] [Indexed: 11/21/2022] Open
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Right-sided scimitar syndrome in a patient with a single aortic trunk and coronary-cameral venous fistula. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2013. [DOI: 10.1016/j.repce.2013.01.006] [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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Isolierte kongenitale Koronaranomalien. Monatsschr Kinderheilkd 2012. [DOI: 10.1007/s00112-012-2813-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Tanabe Y, Tejima T, Sakurada H. Coronary artery fistula with a giant aneurysm treated by percutaneous transradial embolization. Catheter Cardiovasc Interv 2012; 81:732-7. [PMID: 22972663 DOI: 10.1002/ccd.24656] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 08/31/2012] [Accepted: 09/09/2012] [Indexed: 11/06/2022]
Abstract
Coronary artery fistulas are rare anomalies that are very rarely accompanied by an aneurysm. The minimally invasive method of percutaneous transradial embolization, using a thin guiding catheter, was used to treat a coronary artery fistula with an associated giant aneurysm. This technique, not previously described for this type of application, is presented as a case report. The successful outcome of this procedure demonstrated that transradial coronary interventions are useful for treating coronary artery fistulas with an associated giant aneurysm, especially in patients at high risk for conventional surgery or transfemoral interventions.
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Affiliation(s)
- Yauhiro Tanabe
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan.
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Tantiongco JP. An uncommon anatomy presenting with a common disease. BMJ Case Rep 2012; 2012:bcr-2012-006189. [PMID: 22962390 DOI: 10.1136/bcr-2012-006189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Coronary artery fistulas are rare anomalous communications, between coronary arteries and cardiac chambers and great vessels. They are often congenital, but usually present in adulthood. They can affect cardiac haemodynamic stability and are thought to predispose patients to heart failure, myocardial ischaemia, myocardial infarction, infective endocarditis, arrythmias and rupture. Herein, a case is discussed where a patient with long-standing stable angina was found to have a coronary artery fistula to the main pulmonary artery and concomitant ischaemic heart disease with a chronically occluded left anterior descending artery, proximal to the fistula. It is thought that the fistula probably predisposed the patient's ischaemic heart disease. He underwent a successful coronary artery bypass grafting plus surgical ligation of the coronary artery fistula. This uncommon coronary artery anomaly, presenting with ischaemic heart disease, a common disease in adulthood, is discussed in the context of current recommedations.
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Affiliation(s)
- John-Paul Tantiongco
- Department of Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia.
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Takechi M, Yan J, Hitomi J. Rare coronary anastomoses between the aorta, pulmonary trunk, left coronary artery, and subclavian artery. Clin Anat 2012; 25:969-72. [PMID: 22887125 DOI: 10.1002/ca.22141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 07/02/2012] [Accepted: 07/05/2012] [Indexed: 11/11/2022]
Abstract
We report a rare case of coronary anastomoses in an 83-year-old male cadaveric heart. Anomalous vessels arose from the right sinus of the aorta, left main coronary artery, left anterior descending artery, left anterior medial atrial artery, and left subclavian artery. These vessels bifurcated and anastomosed, and finally connected to the pulmonary trunk. The present case is categorized as a multilateral coronary artery fistula in cardiology.
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Affiliation(s)
- Masaki Takechi
- Division of Human Embryology, Department of Anatomy, Iwate Medical University, Iwate, Japan.
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