A Rare Combination of the Left Circumflex Coronary Artery Fistula Connecting a Dilated Coronary Sinus with Persistent Left Superior Vena Cava and Multiple Arteriovenous Fistulae

Abstract

Coronary artery fistula (CAF) is an abnormal communication between an epicardial coronary artery and a cardiac chamber, major vessel or other vascular structures. This report presents a rare case of CAF in which a dilated left main trunk and proximal circumflex coronary artery are connected to a dilated coronary sinus. There were also two other fistulae and persistent left superior vena cava. The coronary fistula was managed conservatively.

Surgical treatment of heart failure due to giant coronary artery fistula: a case report

“…CAF may be asymptomatic, but the gradual dilation of small fistulae may eventually lead to late-onset heart failure. 2,9 Larger fistulae can steal blood from the coronary artery and drain blood flow into lower pressure chambers or veins, which leads to coronary artery ischaemia distal to the fistula. The resulting diastolic pressure gradient can only be compensated by the progressive enlargement of the draining vessel.…”

“…Larger fistulae can steal blood from the coronary artery and drain blood flow into lower pressure chambers or veins, which leads to coronary artery ischaemia distal to the fistula. The resulting diastolic pressure gradient can only be compensated by the progressive enlargement of the draining vessel 5,9–11 . The development of significant left‐to‐right shunt may result in further deterioration of clinical symptoms due to the reduction of coronary perfusion pressure 11 …”

“…The resulting diastolic pressure gradient can only be compensated by the progressive enlargement of the draining vessel. 5,[9][10][11] The development of significant left-to-right shunt may result in further deterioration of clinical symptoms due to the reduction of coronary perfusion pressure. 11 The majority of coronary artery fistulae originate from the right coronary artery (40-60%) and mainly connect to the right atrium, right ventricle, or pulmonary trunk.…”

“…Our case represents an uncommon CAF anatomy 12 where the fistula originated from the LCX and connected to the CS. [9][10][11] This form of CAF is mostly diagnosed in the elderly; however, neonatal cases have also been reported. 11 Although TTE is suitable for the first identification of CAF, [9][10][11] the most effective diagnostic modality is CTA, which provides better inferior temporal resolution compared with cardiac MRI 5,[9][10][11] and can help characterize the CAF in terms of size, feeding vessel, and termination site, which is essential for choosing between a transcatheter or surgical approach.…”

Fístula Coronária Gigante da Artéria Circunflexa para o Seio Coronariano: Diagnóstico Inicial por Ecocardiografia

“…A área mais comum de drenagem é o ventrículo direito, seguido pelo átrio direito, pela artéria pulmonar e pelo seio coronariano. 5 O ecocardiograma transtorácico é usualmente o método inicial de investigação para a maioria das condições cardiovasculares, podendo ser útil na avaliação e no diagnóstico da fístula coronária. É possível a identificação de uma artéria coronária ou câmara dilatada e de uma variedade de defeitos cardíacos congênitos ou adquiridos.…”