Aneurysmal circumflex coronary artery with fistulous connection to the coronary sinus

Kalangos, Afksendiyos; Karaca, Şaziye; Çıkırıkçıoğlu, Mustafa; Vala, Dominique; Didier, Dominique

doi:10.1016/j.jtcvs.2005.02.045

Cited by 10 publications

(18 citation statements)

References 4 publications

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“…1,3,4 It usually remains asymptomatic in childhood, but may develop various symptoms and complications, such as congestive heart failure, endocarditis, coronary steal syndrome, thromboembolism or spontaneous rupture, later in life. 2 The indication for surgical intervention, especially in asymptomatic patients with a diffusely aneurysmal Cx, is poorly defined.…”

Section: Discussionmentioning

confidence: 99%

“…3 Regarding surgical intervention, whether to leave or exclude a diffusely aneurysmal Cx, in addition to ligation of the fistula, is a big issue, considering the risk of later rupture when leaving the aneurysm and sacrifice of the native coronary circulation when excluding the aneurysm. 1 We report a case of an aneurysmal Cx, which finally ruptured into the left atrium after surgical ligation of its fistulous connection to the coronary sinus. …”

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confidence: 97%

“…neurysmal circumflex coronary artery (Cx) with fistulous connection to the coronary sinus is a rare clinical condition, 1 and usually remains asymptomatic until later in life. 2 The therapeutic strategy, including the timing of surgical treatment, is not well defined, especially in asymptomatic patients, and surgical repair is quite challenging.…”

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confidence: 99%

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Rupture of Aneurysmal Circumflex Coronary Artery Into the Left Atrium After Ligation of Its Arteriovenous Fistula

Nakahira

Sasaki

Hirai

et al. 2007

Circ J

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neurysmal circumflex coronary artery (Cx) with fistulous connection to the coronary sinus is a rare clinical condition, 1 and usually remains asymptomatic until later in life. 2 The therapeutic strategy, including the timing of surgical treatment, is not well defined, especially in asymptomatic patients, and surgical repair is quite challenging. 3 Regarding surgical intervention, whether to leave or exclude a diffusely aneurysmal Cx, in addition to ligation of the fistula, is a big issue, considering the risk of later rupture when leaving the aneurysm and sacrifice of the native coronary circulation when excluding the aneurysm. 1 We report a case of an aneurysmal Cx, which finally ruptured into the left atrium after surgical ligation of its fistulous connection to the coronary sinus. Case ReportIn 2001, an asymptomatic 59-year-old man with a continuous heart murmur underwent cardiac catheterization, which revealed an aneurysmal Cx with fistulous connection to the coronary sinus. The pulmonic-to-systemic flow ratio (Qp/Qs) was 2.05 with an anomalous oxygen step-up at the right atrium. However, he rejected any intervention, because of the lack of symptoms. In 2006, he started to feel worsening dyspnea on exertion, and his Qp/Qs became 4.1. The aneurysmal Cx was grossly dilated from its origin and its maximum diameter was 2.5 cm. It pursued a tortuous course along the left posterior atrioventricular groove (Fig 1). In another institution, he underwent external ligation of the fistula and closure of its distal opening into the coronary sinus under cardiopulmonary bypass. He became symptom-free with an equal Qp/Qs and was discharged without any additional dilatation of the aneurysmal Cx in early angiographs.However, at 6 weeks after the operation, he complained of severe, abrupt chest and back pain and was transferred to our institution as an emergency case. On arrival, his blood pressure was 70 mmHg with ST depression in all leads of the electrocardiogram. Several cardioversions were needed to treat the ventricular tachycardias. He was emergently intubated and required intra-aortic balloon pump support, followed by establishment of percutaneous cardiopulmonary support. Echocardiography revealed akinetic inferior and posterolateral left ventricular walls with generalized hypokinesis and an anomalous penetrated shunt from the aneurysmal Cx to the left atrium. Emergency cardiac repair was undertaken under cardiac arrest using cardiopulmonary bypass. The aneurysmal Cx was opened after transection of the pulmonary trunk (Fig 2). The dilated Cx contained a massive adherent thrombus. Saphenous vein grafts were individually bypassed to the left anterior descending coronary artery and a posterolateral branch of the Cx. A right-side left atriotomy clearly showed perforation of the aneurysmal Cx into the left atrium with a 3×4-cm fragile-ended foramen, which was successfully closed using a bovine pericardial patch. After ensuring that there was no bleeding from the excluded portion, the operation Circ J 2007; 71: 1996 -1998 ...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 97%

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Rupture of Aneurysmal Circumflex Coronary Artery Into the Left Atrium After Ligation of Its Arteriovenous Fistula

Nakahira

Sasaki

Hirai

et al. 2007

Circ J

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“…A non-fatal postoperative lateral myocardial infarction was noted in one case. [9] The third treatment modality was transcatheter embolization of the CAF, considered as an alternative to surgical closure, reported in one adult[9] and three children,[10] with complete closure of the fistula and no complications related to the aneurysm. However, aneurysms in these cases were not as large as in our patient.…”

Section: Discussionmentioning

confidence: 99%

An unusual case of left main coronary artery aneurysm with right ventricle fistula

et al. 2012

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A 4-year-old boy presented with repeated respiratory tract infections. Echocardiography showed dilation of the left main coronary artery with flow into the Right Ventricular Outflow Tract (RVOT). Diagnosis of Left Coronary Artery Aneurysm (LMCA) with RVOT fistula was made. A surgical repair of LMCA aneurysm by two-patch technique was performed. The patient had an excellent outcome postoperatively and is asymptomatic on follow-up.

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“…Aneurysmalcircumflex coronary artery with fistulas connection to the coronary sinus (CS) is extremely uncommon. Few patients have been reported in the literature 1‐16 . The majority of cases were symptomatic and presented late in life.…”

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confidence: 99%

Surgical Treatment of Circumflex Coronary Aneurysm with Fistulous Connection to Coronary Sinus Associated with Persistent Left Superior Vena Cava

Darwazah¹,

Eida²,

Batrawy³

et al. 2011

Journal of Cardiac Surgery

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Circumflex coronary arteriovenous fistula associated with aneurysmal dilatation and draining into coronary sinus (CS) is rare. A 57-year-old female presented with progressive dyspnea and was found to have a tortuous multiloculated aneurysm of the circumflex coronary artery terminating into the CS associated with a persistent left superior vena cava. The operative repair and management of coronary arteriovenous fistula are the subject of this case report and review.

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Aneurysmal circumflex coronary artery with fistulous connection to the coronary sinus

Cited by 10 publications

References 4 publications

Rupture of Aneurysmal Circumflex Coronary Artery Into the Left Atrium After Ligation of Its Arteriovenous Fistula

Rupture of Aneurysmal Circumflex Coronary Artery Into the Left Atrium After Ligation of Its Arteriovenous Fistula

An unusual case of left main coronary artery aneurysm with right ventricle fistula

Surgical Treatment of Circumflex Coronary Aneurysm with Fistulous Connection to Coronary Sinus Associated with Persistent Left Superior Vena Cava

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