Anesthesia for Surgical Correction of Coronary Artery Fistula without Extracorporeal Circulation: Case Report

Soares, Raquel Reis; Drumond, Leonardo Ferber; Araújo, Leonardo Alves; Drumond, Matheus Ferber; Lorentz, Michelle Nacur

doi:10.1016/s0034-7094(11)70086-1

Cited by 3 publications

(4 citation statements)

References 15 publications

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“…It is common sense that patients affected by coronary artery fistulae should be considered at high risk of acute heart failure due to coronary ischemia. 8 In the case reported herein, we hypothesized that during permissive arterial hypotension, which was achieved before tachycardia and atrial fibrillation, the pressure inside the tortuous and ectatic vascular structure of the fistula decreased, diverting the blood flow away from the coronary tree toward the pulmonary artery trunk due to a change in the pressure gradient between the inflow and outflow fistula branches. This hemodynamic context could have triggered a steal-like phenomenon from the LAD, causing a large area of transient myocardial hypoperfusion, as suggested by the increase in troponin to 0.055 ng/ mL, versus a normal value <0.045 ng/mL, with consequent electrical instability.…”

Section: Discussionmentioning

confidence: 87%

A Complex Coronary Artery Fistula as a Potential Cause of Sudden Intraoperative Hemodynamic Compromise: A Case Report

Deana

Baron

Barbariol

et al. 2020

Semin Cardiothorac Vasc Anesth

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A patient with coronary artery fistula should be considered as high risk for intraoperative hemodynamic decompensation. In this article, we report the case of a 70-year-old man affected by a complex congenital coronary artery fistula defect. The patient underwent general anesthesia for spine surgery with permissive hypotension. The development of sudden intraoperative tachyarrhythmia with hemodynamic instability required immediate resuscitation and interruption of surgery. The claim advanced is that in patients with a coronary artery fistula permissive hypotension might be considered an option only if strictly necessary and real-time cardiac monitoring including transesophageal echocardiography is available to immediately detect and treat acute cardiac impairment.

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Section: Discussionmentioning

confidence: 87%

A Complex Coronary Artery Fistula as a Potential Cause of Sudden Intraoperative Hemodynamic Compromise: A Case Report

Deana

Baron

Barbariol

et al. 2020

Semin Cardiothorac Vasc Anesth

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“…Central venous access and/or pulmonary arterial catheterisation may also be considered. Peri‐operative cardiovascular collapse, ST‐segment changes, myocardial infarction, pericardial tamponade, fistula dissection and coronary spasm have been all described, therefore, peri‐operative vigilance was essential [ 5 , 11 ]. Appropriate understanding of the potential physiologic consequences of CAVF and how they interact with the physiologic changes of pregnancy and delivery are essential for the management of these cases.…”

Section: Discussionmentioning

confidence: 99%

Anaesthetic management of a parturient with an unrepaired coronary arteriovenous fistula for caesarean section

King,

Al‐Nahdi,

Ludwig

2024

Anaesthesia Reports

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SummaryCoronary arteriovenous fistulas are an abnormal conduit between a coronary artery and another cardiovascular lumen, without an intervening capillary bed. The reported prevalence is 0.002–0.3%. Physiologic consequences such as congestive heart failure, coronary steal phenomenon and fistula aneurysm formation and rupture are possible. There are limited reports of symptomatic coronary arteriovenous fistulas in association with pregnancy. We describe a 19‐year‐old woman with symptomatic left circumflex artery to coronary sinus fistula, terminating into a large exophytic varix in the right atrium, presenting for an elective caesarean section at 37 weeks gestational age. Our anaesthetic management strategy aimed to optimise myocardial perfusion, maintain euvolemia, avoid right ventricular obstruction from exophytic varix and avoid sympathetic stimulation or sudden increases in pulmonary vascular resistance. A slowly titrated epidural was used as the primary anaesthetic. Our patient tolerated the procedure well and was discharged home on postoperative day two. Understanding of the potential physiologic consequence of coronary arteriovenous fistulas, and interaction with the physiologic changes of pregnancy and delivery, are essential for the management of these cases.

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“…Normovolemia and normal heart rate to decrease coronary steal and pulmonary artery hyperflow as well as maintaining an anesthetic plane to prevent sympathetic hyperactivity are utmost important for the favorable outcome of these patients. [ 5 ]…”

Section: Discussionmentioning

confidence: 99%

“…Abnormal connections between the main coronary artery and its branches with other major thoracic vessels or with the heart chambers represent a rare clinical entity with an incidence of 0.002%–0.32% among the general population, with a male to female ratio of 1.9:1 although at least 50% of these cases are asymptomatic, discovered incidentally and more often congenital than other acquired forms (traumatic, iatrogenic, or associated to cardiac neoplasms). [ 1 2 3 4 5 ] Meanwhile, the incidence reported for cardiac hemangiomas is 2.8% among all primary heart neoplasms and are classified as cavernous, capillary, or arteriovenous hemangioma according to their histological features. [ 4 6 ]…”

Section: Introductionmentioning

confidence: 99%

Anesthetic implications for coexisting cardiac capillary hemangioma and multiple coronary artery to pulmonary artery fistulas

2018

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Abnormalities of the coronary vascular branches and cardiac hemangiomas represent together unusual clinical entities, with an incidence difficult to establish for the former as the vast majority of the patients with these anomalous vascular connections are usually asymptomatic and 2.8% for the latter. Symptomatic patients may develop dyspnea on exertion or chest pain secondary to a “coronary steal” phenomenon as part of the underlying pathophysiology of the disease. The authors report a case of a patient with concomitant cardiac capillary hemangioma with multiple coronary to pulmonary artery fistula connections that was successfully treated with surgical resection of the tumor and ligation of the fistula tracts. A comprehensive and balanced anesthesia management aimed to preserve tight hemodynamic stability to avoid increased myocardial demand and worsening of the coronary steal becomes essential in these patients.

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Anesthesia for Surgical Correction of Coronary Artery Fistula without Extracorporeal Circulation: Case Report

Abstract: Coronary artery fistula is rare, but the anesthesiologist may be faced with this type of patient in distinct situations. Understanding its pathophysiology is important for better perioperative management of the patient, therefore improving the prognosis.

Cited by 3 publications

References 15 publications

A Complex Coronary Artery Fistula as a Potential Cause of Sudden Intraoperative Hemodynamic Compromise: A Case Report

A Complex Coronary Artery Fistula as a Potential Cause of Sudden Intraoperative Hemodynamic Compromise: A Case Report

Anaesthetic management of a parturient with an unrepaired coronary arteriovenous fistula for caesarean section

Anesthetic implications for coexisting cardiac capillary hemangioma and multiple coronary artery to pulmonary artery fistulas

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