Acquired postoperative coronary arteriovenous fistula

Abstract

A patient is described who underwent closed mitral valvotomy and presented 21 years later with left ventricular failure. Coronary angiography revealed a coronary artery to pulmonary vein arteriovenous fistula. This is the first report of an acquired fistula of this type developing secondary to trauma associated with cardiac surgery. Diagnosis and treatment implications are discussed.

Acquired coronary-to-bronchial artery fistula after two valve surgeries

“…In one report of acquired diagonal artery-to-pulmonary vein fistula 30 years after open mitral commissurotomy, it was suggested that CAF might be caused by blunt trauma over the anterior left ventricle during surgery or chest tube positioning. 3 In our patient, the Takayasu arteritis was well controlled and not currently active. There are two possibilities: CBF was formed by longstanding Takayasu arteritis that resulted in the pulmonary arterial disease, or by mediastinal adhesions and inflammation attributable to the 2 previous cardiac operations.…”

“…2 For the coronary-to-systemic type, fistulous communications may terminate directly in a cardiac chamber, the bronchial circulation, the coronary sinus or vein, or the venae cavae. 3 Among coronary-to-systemic fistulae, coronary-tobronchial artery fistula (CBF) has been reported in 0.61% on cardiac multidetector computed tomography. 4 A CBF can present secondary to occlusive disease of the pulmonary arteries or chronic pulmonary inflammation, such as bronchiectasis or cystic fibrosis.…”

“…2 For the coronary-to-systemic type, fistulous communications may terminate directly in a cardiac chamber, the bronchial circulation, the coronary sinus or vein, or the venae cavae. 3…”

Acquired coronary artery fistula after open heart surgery for congenital heart disease

“…In this report, right ventricular myotomy or right ventricular myomectomy was considered as an important factor in acquired coronary artery fistula and close observation was suggested in these patients. Acquired coronary artery fistulas were also reported in the literature in two tetralogy of Fallot patients [8,9], two double outlet right ventricle with pulmonary stenosis patients [10,11], two ventricular septal defect patients [11,12], one mitral stenosis patient [13], and in many hypertrophic cardiomyopathy patients following cardiac surgery [6,14,15]. The pathogenesis of acquired coronary artery fistula after open heart surgery is not clear to us.…”