Acute myocardial infarction due to thrombus formation in congenital coronary artery fistula

Abstract

A young female patient developed acute myocardial infarction during physical exercise. Coronary arteriography in the acute phase demonstrated a coronary fistula originating from the left coronary main trunk and communicating with the right atrium. Several branches of the left coronary artery were obstructed by thrombotic material originating from the fistula, causing an acute myocardial infarction.

Dutch survey of coronary artery fistulas in adults: Congenital solitary fistulas

“…Acute myocardial infarction is considered a rare complication of CAFs [21][22][23]. It has been postulated that acute MI is presumably due to thrombotic embolism originating from the coronary artery fistula [21].…”

“…It has been postulated that acute MI is presumably due to thrombotic embolism originating from the coronary artery fistula [21]. But regarding the involvement of the segment of the fistularelated arteries, proximal to the origin of the fistula, Bauer postulated that elevated shear stress due to increased flow velocity and turbulence may predispose a vessel to accelerated atherosclerosis and thrombosis, resulting in occlusion of distal flow, increased intraluminal pressure, and rupture of the weakened wall [24].…”

Myocardial Infarction in a 14-Year-Old Girl, Ten Years After Surgical Correction of Congenital Coronary Artery Fistula

“…The etiology of myocardial infarction in these cases was explained by a ''coronary steal'' phenomenon. Intraluminal thrombus formation in CAF before surgical repair with subsequent development of myocardial infarction was first reported by K. Shira in Japan in an 18-year-old girl following vigorous exercise [11]. An intraluminal thrombus obstructing the LAD was demonstrated on angiogram.…”

Congenital Left Main Coronary Artery to Main Pulmonary Artery Fistula with Bicuspid Aortic Valve: A Case Report and Review of Literature

“…In a review of 174 patients, fistula‐related complications such as congestive heart failure (12%), myocardial infarction (4%), bacterial endocarditis (3%), and death (6%) occurred; with an overall complication incidence of 21% 13 . Other complications including giant aneurysmal dilatation of fistula, 25 fistula dissection and rupture with cardiac tamponade, 26 embolization of mural thrombi to the distal coronary bed with subsequent myocardial infarction, 27 and sustained ventricular tachycardia 28 have also been reported. All of these complications are life‐threatening.…”