A Case Report of Coronary Arteriovenous Fistulas with an Unruptured Coronary Artery Aneurysm Successfully Treated by Surgery

Takeuchi, Nobuhiro; Takada, Masanori; Nishibori, Yoshiharu; Maruyama, Takao

doi:10.1155/2012/314685

Cited by 9 publications

(19 citation statements)

References 17 publications

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“…55% of fistulas originate from the right coronary artery, 35% of the left coronary artery and less than 10% of both [1,2].…”

Section: Discussionmentioning

confidence: 99%

A Case Report of Coronary Fistula with ST Segment Elevation Myocardial Infarction

Gamba¹

2017

Austin J Clin Cardiolog

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A patient presented with a ST Segment Elevation Myocardial Infarction (STEMI). The Coronarography revealed multivessel disease and the emergence of a coronary fistula that is directed towards the aorta. The culprit vessel was treated with primary percutaneous coronary intervention with subsequent treatment with coronary artery bypass graft surgery. Keywords: Coronary fistula; Myocardial infarction Case PresentationA 61-year-old male presented with burning chest pain of medium intensity, diaphoresis, dyspnea and evacuation desire, the electrocardiogram revealed sinus rhythm with first degree atrioventricular block and ST Segment Elevation, positive cardiac biomarkers, confirming the diagnosis of ST Segment Elevation Myocardial Infarction (STEMI).Patient underwent urgent coronary angiography that revealed Right Coronary Artery (RCA) with total thrombotic occlusion in the proximal-middle segment; it was observed an abnormal vessel with independent origin just above the ostium of the RCA, directed towards the aorta (Figure 1).Left main with 50% distal obstruction, circumflex artery presents a tandem lesions on a marginal branch of 80%, Left Anterior Descending (LAD) with proximal ectasia and severe diffuse lesions in the proximal and middle segments (90%) and was observed the emergence of great caliber vessel through proximal ectasia and that is directed towards the aorta (coronary fistula) (Figure 2).It was decided to perform the primary coronary intervention (p-ICP) of the culprit vessel, RCA lesion was managed by thromboaspiration and a subsequent stenting, being necessary to splice from distal to proximal 3 Bare Metal Stents (BMS), with 0% of residual lesion confirmed by stent boost technique, with presence of epicardial TIMI III flow and no complications (Figure 3). Two weeks later a coronary CT was performed to evaluate the fistula anatomy reconstruction finding a vessel of 1.7mm of diameter and the origin at 8 mm from de ostium directed through aorta ( Figure 4).Patient was programmed after a one month of the acute event for subsequent Coronary Artery Bypass Graft surgery (CABG) for coronary revascularization with left internal mammary artery to LAD, inverted saphenous venous hemoducts to the marginal branch and closure of the left fistula, five days before the intervention ticagrelor was stopped and continued taking aspirin, and following CABG he started taking clopidogrel.

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“…55% of fistulas originate from the right coronary artery, 35% of the left coronary artery and less than 10% of both [1,2].…”

Section: Discussionmentioning

confidence: 99%

A Case Report of Coronary Fistula with ST Segment Elevation Myocardial Infarction

Gamba¹

2017

Austin J Clin Cardiolog

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“…The majority of these fistulas arise from the right coronary artery (RCA) (33-55%) or the left anterior descending artery (35-49%). The circumflex coronary artery is rarely involved (17-18%) [10,11,14,23,27,28,29]. A single origin is the most common form of CAF, ranging from 74 to 90% of cases [3,11,17].…”

Section: Introductionmentioning

confidence: 99%

“…A single origin is the most common form of CAF, ranging from 74 to 90% of cases [3,11,17]. The left and right coronary systems are simultaneously involved in approximately 4-18% of reported cases [4,7,10,14,17,22,29,30]. CAFs commonly drain into low-pressure structures.…”

Section: Introductionmentioning

confidence: 99%

“…These include the right ventricle (40%), right atrium (26%), pulmonary artery (17%), coronary sinus (7%), and superior vena cava (1%). However, drainage of CAFs into left-sided chambers is less frequent (left atrium, 5%; left ventricle, 3%) [10,11,14,17,23,28,29,31,32]. …”

Section: Introductionmentioning

confidence: 99%

“…They comprise 13-50% of congenital coronary artery anomalies [3,5,9,10,11,12]. Communications between the coronary arteries and the cardiac chambers are thought to develop during coronary artery development.…”

Section: Introductionmentioning

confidence: 99%

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Coronary Artery Fistulas: Case Series and Literature Review

Karazisi

Eriksson²,

Dellborg³

2016

Cardiology

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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.

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Unilateral and Multilateral Congenital Coronary‐Pulmonary Fistulas in Adults: Clinical Presentation, Diagnostic Modalities, and Management With a Brief Review of the Literature

Saïd

Nijhuis

Akker

et al. 2014

Clinical Cardiology

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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.The authors have no funding, financial relationships, or conflicts of interest to disclose.

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A Case Report of Coronary Arteriovenous Fistulas with an Unruptured Coronary Artery Aneurysm Successfully Treated by Surgery

Cited by 9 publications

References 17 publications

A Case Report of Coronary Fistula with ST Segment Elevation Myocardial Infarction

A Case Report of Coronary Fistula with ST Segment Elevation Myocardial Infarction

Coronary Artery Fistulas: Case Series and Literature Review

Unilateral and Multilateral Congenital Coronary‐Pulmonary Fistulas in Adults: Clinical Presentation, Diagnostic Modalities, and Management With a Brief Review of the Literature

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