Acute Heart Failure From Coronary Cameral Fistula

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. )

Transcatheter closure of a large coronary cameral fistula presenting as a calcified cystic right atrial mass

“…5 Congestive heart failure is a rare complication from coronary cameral fistulas. 1,2,6 Asymptomatic coronary cameral fistulas without evidence of chamber enlargement, ventricular dysfunction, coronary ischemic steal, or arrhythmias can be monitored every three to 5 years. If there are symptoms of ischemia on exercise stress testing, progressive cardiac chamber enlargement or ventricular dysfunction, or new arrhythmias related to the fistula, closure is recommended 7,8 (Figure 5).…”

“…In congenital fistulas, symptoms often present in the third or fourth decade of life 5 . Congestive heart failure is a rare complication from coronary cameral fistulas 1,2,6 . Asymptomatic coronary cameral fistulas without evidence of chamber enlargement, ventricular dysfunction, coronary ischemic steal, or arrhythmias can be monitored every three to 5 years.…”

“…1 While typically asymptomatic and incidentally found, coronary cameral fistulas can lead to cardiac chamber dilatation along with congestive heart failure. 2 If symptomatic, significant coronary cameral fistulas may require surgical or transcathether treatment. 1,3 We present a case of symptomatic right heart dysfunction from a coronary cameral fistula initially presenting as a calcified right atrial mass for which percutaneous transcatheter closure was performed.…”

“…Coronary cameral connections, which are abnormal arterial malformations of the coronary arteries connecting to adjacent structures, are present in less than 1% of the population 1 . While typically asymptomatic and incidentally found, coronary cameral fistulas can lead to cardiac chamber dilatation along with congestive heart failure 2 . If symptomatic, significant coronary cameral fistulas may require surgical or transcathether treatment 1,3 .…”