Aneurysmal coronary arteriovenous fistula closing with covered stent deployment: A case report and review of literature

Ghaffari, Samad; Akbarzadeh, Fariborz; Pourafkari, Leili

doi:10.5603/cj.2011.0013

Cited by 10 publications

(9 citation statements)

References 25 publications

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“…In cases of giant aneurysms, aneurysm resection, coronary artery reconstruction and concomitant coronary bypass are usually planned (13,15). Recently, transcutaneous closure to treat coronary artery fistulas and aneurysms has been attempted using covered or noncovered stent, coils, Amplatzer muscular VSD devices, Amplatzer duct occluder devices and Gianturco Grifka vascular occlusion devices (1,(23)(24)(25)(26). We also experienced a patient with a coronary artery right atrial fistula in whom we closed the fistula with a coronary stent and multiple coils, monitoring the coronary flow changes with a Doppler guide wire (27).…”

Section: Discussionmentioning

confidence: 99%

An Extremely Large Coronary Aneurysm Associated with a Quadricuspid Aortic Valve in an Adult Patient

et al. 2013

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A 68-year-old woman exhibited an increasingly protruding mass on the left heart border on chest X-ray. Transthoracic echocardiography revealed an echo-free mass in the anterior pericardial space. Transesophageal echocardiography revealed blood flow from the proximal left anterior descending coronary into a large coronary artery aneurysm measuring 61 mm × 51 mm in diameter and a quadricuspid aortic valve with a small cusp between the left and right coronary cusps. Coronary angiography demonstrated the presence of a coronary aneurysm connected to the proximal left coronary anterior descending artery. A giant coronary artery aneurysm and pulmonary artery fistulas extending from the left and right coronary arteries were confirmed by surgeons and successfully treated with surgery.

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Section: Discussionmentioning

confidence: 99%

An Extremely Large Coronary Aneurysm Associated with a Quadricuspid Aortic Valve in an Adult Patient

et al. 2013

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“…Aneurysm formation has been reported in around one in five cases. 5 Rupture of these aneurysms is rare and usually occurs in large ones. Ruptured aneurysm may clinically be presented as chest pain, pericardial effusion, cardiac tamponade, or even sudden cardiac death and could mimic the presentation of acute aortic dissection.…”

Section: Discussionmentioning

confidence: 99%

Aneurysmal Coronary Artery Fistulae: How Big is Big Enough?

Jaiswal

Park

2013

Int J Angiol

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).Coronary artery fistula (CAF) is a rare anomaly through which coronary blood flow is usually shunted into either a cardiac chamber, great vessel, or other structures, bypassing the myocardial capillary network. Usually, it is detected as an incident finding during coronary angiography, other noninvasive thoracic imaging or occasionally, incidental finding of a continuous murmur, characteristically heard over the left sternal border and at the apex might be present. The detection has recently increased because of the widespread use of diagnostic modalities including coronary angiography, multidetector computed tomography, and magnetic resonance imaging for other diseases. 1 It is reported to be present in approximately 0.2% of routine coronary angiograms. 2 However, symptomatic cases with complications such as high-output heart failure, pulmonary hypertension, myocardial ischemia, and infective endocarditis have been reported. Treating physicians are usually on crossroads in cases with asymptomatic detection because of lack of consensus on the management strategy. Data on presumed low sudden death rate in asymptomatic patients are limited because of lack of large studies with long followups. With increasing detection of asymptomatic cases, it is prudent to revise our traditional approach. In this article, we cross-examine the conventional approach with different views and suggest an alternative strategy by eliciting our case. Case ReportA 78-year-old hypertensive woman with episodic chest pressure was referred to our cardiac catheterization laboratory for angiographic evaluation. Patient recently immigrated to United States in her usual health status 3 months ago. She started developing present symptoms 2 months before her clinic visit and initially attributed these symptoms to her underlying chronic acid reflux. Progression of symptoms infrequency and severity led to follow-up visit and was referred to emergency room for further evaluation. Patient had a prior coronary angiographic evaluation for similar symptoms 5 years ago in her native country, and she was told to have normal findings. However, results were unobtainable.Physical examination revealed a blood pressure of 158/ 78 mm Hg, and a regular pulse of 86 beats per minute. Electrocardiography showed nonspecific ST-T wave changes. The cardiologist decided to proceed with coronary angiography that revealed mild luminal irregularities and preserved left ventricular systolic function. In addition, angiography also showed a left anterior descending coronary artery to main pulmonary trunk fistula with an in-between saccular aneurysm. The aneurysm was 2.0 Â 2.5 cm in maximum dimension (►Fig. 1). The CAF feeding this aneurysm was less than 2 mm in diameter. A right heart catheterization was Keywords ► coronary artery fistula ► coronary angiography ► coronary aneurysm ► transcatheter interventions ► coils AbstractCoronary artery fistula (CAF) is the most common congenital anomaly of coronary arteries. Management strategies for CAF causing symptoms and large shun...

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“…Particularly uncommon, fistulae can also be associated with coronary aneurysms. In such aneurysmal formations, mainly if large and sacular, surgery might be considered, due to rupture risk [3], although good results have been reported with covered stent deployment [4].…”

Section: Discussionmentioning

confidence: 99%

Cardiac tamponade as a rare complication after giant coronary fistula percutaneous closure

Villanueva¹,

Cebada²,

Ibañes³

et al. 2013

WJCD

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We present the case of an unusual complication after percutaneous closure of a giant coronary artery fis-tula. A 76-year-old man with previous admissions due to right heart failure and previous history of atrial fibrillation under acenocumarol, was admitted to our hospital for new onset of symptoms, characterized by progressive dyspnoea and peripheral edema. Physical examination revealed signs of congestive heart failure and a continuous murmur loudest along the lower sternal border. X-Ray showed cardiomegaly due to right chambers dilatation. Transthoracic echocardiography showed right chambers pressure and volume overload, with right ventricular enlargement and dysfunction, tricuspid annulus dilatation and severe tricuspid regurgitation. Cardiac catheterization showed significant elevation of right atrial pressure, as well as significant step-up of oxygen saturation in this chamber. Coronary angiography revealed the presence of a large fistula between the circumflex coronary artery (CCA) and coronary sinus (CS), with severe dilation of the CCA (maximum diameter20 mm). An Amplatzer^? PDA was implanted in a distal elbow of the fistula with initailly good results. Anticoagulant therapy was then reinitiated, and a few days later, the patient developed clinical worsening of heart failure and dyspnoea. Echocardiogram showed significant pericardial effusion. Pleuropericardial window was then made draining a500 cm³ of bloody pericardial effusion. The postoperative outcome was excellent, with symptomatic relief and no signs of heart failure.

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Aneurysmal coronary arteriovenous fistula closing with covered stent deployment: A case report and review of literature

Cited by 10 publications

References 25 publications

An Extremely Large Coronary Aneurysm Associated with a Quadricuspid Aortic Valve in an Adult Patient

An Extremely Large Coronary Aneurysm Associated with a Quadricuspid Aortic Valve in an Adult Patient

Aneurysmal Coronary Artery Fistulae: How Big is Big Enough?

Cardiac tamponade as a rare complication after giant coronary fistula percutaneous closure

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