Misguided diversions: coronary artery fistulae

Leong, Kai’En; Joshi, S.; Grigg, Leeanne

doi:10.1093/eurheartj/ehx185

Cited by 2 publications

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“…The clinical presentation, symptomatology, and influence of CAF on hemodynamics depend on its size, shunt direction, and location. [ 7 ] Most patients with CAFs remain asymptomatic in the first 2 decades of life, especially in patients with smaller shunt volumes that are incidentally found. However, as the size of the fistula increases, more hemodynamic effects occur.…”

Section: Discussionmentioning

confidence: 99%

“…Progressive enlargement of a fistula may result in a prime pathologically significant large fistula, called “coronary steal,” causing myocardial hypoperfusion distal to the fistulous connection. [ 7 ] In severe cases, pulmonary hypertension, ruptured aneurysm, heart failure, arrhythmia, myocardial infarction, newly infected endocarditis, sudden cardiac death, and other severe complications may occur. However, in typical cases, patients experience exertional dyspnea, fatigue, angina, or palpitations.…”

Section: Discussionmentioning

confidence: 99%

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A rare case of dual congenital coronary cameral fistula and myocardial bridge

Shen¹

2022

Medicine

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Rationale:A coronary artery fistula (CAF) is an anomalous communication between a coronary artery and a cardiac chamber or great vessel. It is a rare congenital anomaly that is often small and asymptomatic, occurring in only 0.002% of the general population. Most CAFs originate from the right coronary artery and flow into the right cardiac system. Although extremely rare, some cases may originate from the bilateral coronary arteries and flow into the left ventricle.Patient concerns:Herein, we report a rare case of a 55-year-old male smoker with no history of heart disease or cardiac surgery, who presented with a 5-year history of recurrent chest congestion, palpitations, and shortness of breath. On physical examination, his heart and lungs revealed normal findings without cardiac murmurs and no systemic or pulmonary edema. Moreover, 24-hour ambulatory electrocardiography showed no signs of ischemia but exhibited a short array of ventricular tachycardia and short atrial tachycardia. Chest computed tomography showed left apical emphysema without cardiomegaly and pulmonary congestion. Furthermore, coronary angiography revealed dual congenital coronary cameral fistula, a complex CAF with a left circumflex artery–left ventricle fistula and a right coronary artery–left ventricle fistula, complicated with a myocardial bridge.Diagnosis and interventions:A diagnosis of left circumflex artery–left ventricle fistula complicated with a right coronary artery–left ventricle fistula and myocardial bridge was made. Since the patient refused surgery, medical management with enteric-coated aspirin, sustained-release metoprolol, and atorvastatin calcium was initiated.Outcomes and lesson:Currently, the patient is now asymptomatic and in good condition since 6 months after undergoing conservative treatment with β-blockers.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A rare case of dual congenital coronary cameral fistula and myocardial bridge

Shen¹

2022

Medicine

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Takotsubo Syndrome and Coronary Artery Fistula: Case Report and Literature Review

Elikowski¹,

Angerer²,

Fertała³

et al. 2023

Polski Merkuriusz Lekarski

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Takotsubo syndrome (TTS) has been reported in various clinical conditions. Coronary artery fistula (CAF) is diagnosed in 0.2- 0.4% of patients undergoing coronary angiography. Pathologic communication between coronary artery (e.g., left anterior de¬scending coronary artery – LAD) and cardiac chambers (e.g., left ventricle – LV) is cameral type of CAF which particularly predis¬pose to myocardial ischemia due to a steal syndrome. Eight cases of coexistent TTS and CAF have been reported so far; in 6 of them LAD cameral fistulas drained LV, in 2 others communications between coronary arteries and pulmonary artery were found. The authors describe a case of a 75-year-old female, admitted due to chest pain and dyspnea. Her clinical picture with ST-segment elevation in ECG, moderately increased troponin I and apical ballooning in echocardiography, was more typical for TTS than for myocardial infarction; besides that, color doppler imaging was suggestive of multiple CAF to LV. Coronary angiography showed communication between all (normal) coronary arteries and LV. Throughout the conservative therapy, first, an improve¬ment and then normalization of LV function were observed after 2 and 6 days, respectively. Chest x-ray and computed tomogra¬phy revealed mediastinal tumor (eventually diagnosed as lung cancer). Cardiac magnetic resonance performed after one month did not show late gadolinium enhancement. During the course of 24 months follow-up, she was taking bisoprolol and ramipril and her cardiologic state remained stable, even during chemotherapy and radiotherapy. The authors collected the clinical data of all 9 cases with concomitant TTS and CAF. Specific TTS triggering factors/predisposing conditions were present in all patients, which has indicated that coexistence of TTS and CAF is rather coincidental.

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Misguided diversions: coronary artery fistulae

Cited by 2 publications

References 0 publications

A rare case of dual congenital coronary cameral fistula and myocardial bridge

A rare case of dual congenital coronary cameral fistula and myocardial bridge

Takotsubo Syndrome and Coronary Artery Fistula: Case Report and Literature Review

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