Bilateral coronary-to-pulmonary artery fistulas associated with giant aneurysm in an elderly woman: Case report and literature review

Abstract

Coronary artery fistula is an abnormal vascular communication of coronary artery with cardiac chambers or any segment of the systemic or pulmonary circulation. The prevalence is 0.9% of all coronary anomalies. Coronary artery fistula arises from the right coronary artery in approximately 50.0% of patients, from left coronary artery in approximately 42.0% of patients, and from both in approximately 5.0% of patients. Low-pressure structures are the most common sites of drainage of the coronary fistulas. If a large left-to-right shunt exists, it can be associated with potential complications, such as arterial aneurysm. Here we report an extremely rare case of a 76-year-old woman with bilateral coronary-to-pulmonary artery fistulas associated with giant aneurysms, detected by coronary angiography and confirmed with coronary computed tomography.

A Phenotype and Genotype Case Report of a Neonate With Congenital Bilateral Coronary Artery Fistulas and Multiple Collateral Arteries

“…Interventional treatment, catheterizations, or/ and surgery, should be considered in the case of substantial shunt, significant aneurysmal formation, or presence of other cardiac malformations ( 21 , 22 ). Cardiac catheterization was firstly performed on our patient to coil-occlude two of the collateral arteries.…”

Congenital coronary artery-to-pulmonary fistula with giant aneurysmal dilatation and thrombus formation: a case report and review of literature

“…CPAF, defined as the abnormal vascular communication originating from the coronary artery and draining into the pulmonary artery, accounts for 15.0-30.0% of all coronary artery fistulas (CAF), with the prevalence from 0.17 to 0.68% in the general population [3][4][5]. Most CPAF can be classified as the anterior type characterized by connecting the proximal portion of the left or right coronary artery and the anterior wall of the pulmonary artery.…”

“…As for the treatments, surgical ligation should always be an option, especially when the patient is symptomatic, CPAF is hugely tortuous, multiple CPAFs exist, CPAF is high-flow, or CPAF combines with the giant coronary aneurysm or infective carditis [6,17]. Endovascular embolization might also be adopted if CPAF locates proximally and consists of a single narrow drainage site without concomitant cardiac disorders requiring surgery [3,18]. Although no consensus exists regarding the oral medication regimen, several cases utilize antiplatelet medicine, anticoagulants, beta-blockers, and calcium channel blockers to prevent thrombosis and control symptoms [2].…”

“…2 Coronary angiography identified a coronary artery to pulmonary artery fistula with giant aneurysmal dilation through Left Anterior Oblique angulation Fig. 3 We spotted the coronary aneurysm of 3 cm in diameter located within the epicardial adipose tissue during surgery shunt, performed aneurysmorrhaphy, and excised the excess aneurysmal wall for histological analysis. The result revealed moderate intimal fibrosis, degenerated media, and decreased smooth muscle layer without evidence of inflammation, vasculitis, or atherosclerosis (Fig.…”

“…However, it could also manifest as angina pectoris, congestive heart failure, pulmonary hypertension, or even sudden cardiac death depending on the severity of the left-right shunt and whether a concomitant ruptured aneurysm exists [2]. The treatment regimen for CPAF, including oral antiplatelet or anticoagulant medications, interventional endovascular procedures, and ultimately, surgical ligation, should be individually tailored [3]. Here we report a rare case of CPAF with coronary aneurysmal formation and concomitant thrombosis.…”