Communicating bilateral coronary artery to pulmonary artery fistula with aneurysm in asymptomatic patient: Successful conservative management with selective coil embolization of the aneurysm

Renard, C.; Chivot, Cyril; Jarry, G; Houpe, D.; Remond, A; Leborgne, Laurent

doi:10.1016/j.ijcard.2010.02.062

Cited by 7 publications

(11 citation statements)

References 7 publications

(23 reference statements)

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“…Approximately, 40% were managed conservatively, 27% has coil embolization, 27% had surgical treatment, and 13% had catheter-mediated occlusion of the fistula. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] Dodge-Khatami et al 17 have classified CAFs as follows:…”

Section: Discussionmentioning

confidence: 99%

“…5,7 Most patients with CAF remain asymptomatic, but elderly patients can present with exertional chest pain and dyspnea, fatigue, congestive heart failure, palpitations, or arrhythmias. 1,2,5,8 Most fistulas are small and hemodynamically inconsequential. However, some can be large and lead to preferential blood flow from coronary circulation to low-pressure pulmonary circulation, resulting in pulmonary hypertension and coronary-steal-related chronic myocardial ischemia.…”

Section: Discussionmentioning

confidence: 99%

“…However, it is an invasive procedure that provides two-dimensional images that may not be able to clearly define fistula course and anatomical relationship with other adjacent structures. 8 A newer technology, like multidetector row computed tomography, is a noninvasive tool recommended by the American Heart Association Committee to evaluate suspected or known CAF. 12,13 Transthoracic echocardiography with color flow imaging can demonstrate a CAF noninvasively.…”

Section: Discussionmentioning

confidence: 99%

“…Percutaneous transcatheter closure is the safe and preferred method for anatomic approachable vessels. [2][3][4]8,[14][15][16]…”

Section: Discussionmentioning

confidence: 99%

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Diagnosis of Coronary Artery Fistulas: Clinical Aspects and Brief Review of the Literature

2013

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An 86-year-old woman with a history of hypertension, diabetes, coronary artery disease, and arrhythmias was presented to the emergency department with a productive malaise, fever, worsening shortness of breath, and diaphoresis. The patient was normotensive, tachycardic, hypoxic, with regular heart sounds without associated murmur with clinical evidence of congestive heart failure (distension of jugular veins and bilateral basal lung crackles).A 12-lead electrocardiogram revealed sinus tachycardia with a heart rate of 124 beats per minute with new T-wave inversions in lead aVL, and ST depressions in leads V5 and V6. Beta natriuretic peptide was 546 pg/mL. Chest X-ray demonstrated diffuse pulmonary edema.The patient initially was placed on a nitroglycerin drip; however, her blood pressure dropped substantially, and therefore, this medication had to be discontinued. The patient also received nebulizer treatments and oxygen that resulted in improvement of her clinical condition. She was admitted for management of congestive heart failure and pneumonia. She was started on medical treatment of pneumonia (Levofloxacin, Sagent Pharmaceuticals, Schaumburg, IL) and congestive heart failure (furosemide, β-blockers, and angiotensin-converting enzyme inhibitor). Echocardiogram demonstrated multiple wall motion abnormalities, ejection fraction of 30 to 35% with almost global hypokinesis with akinetic areas in the mid septal, basal inferior, and inferoseptal areas, two-fourth diastolic dysfunction, mild mitral regurgitation, and mild pulmonary hypertension. Cardiac catheterization revealed severe triple vessel disease with left dominant system, and aneurysmal left main disease with a critical lesion of proximal circumflex with ulcerated plaque that was subsequently stented. The patient also had a 70% proximal left anterior descending (LAD) lesion and coronary artery to pulmonary artery fistulas originating from the left main coronary artery (►Fig. 1) and right coronary artery (►Fig. 2) with small shunt flow. DiscussionCoronary artery fistula (CAF) is an abnormal communication between a coronary and a heart chamber or any segment of the systemic or pulmonary circulation. These are often grouped together as coronary arterial-venous fistulas. A coronary artery connection to the pulmonary Keywords ► congestive heart failure ► fistulas ► cardiac catheterization ► angiography ► coronary arteries AbstractAn 86-year-old woman with history of hypertension, diabetes, hyperlipidemia, and coronary artery disease was admitted with new-onset congestive heart failure and pneumonia. She underwent coronary angiography after suffering a non-ST elevation myocardial infarction. There was severe coronary artery disease in addition to coronary artery-pulmonary fistulas involving proximal right coronary artery and a branch of left main coronary artery. Coronary artery fistula (CAF) is an abnormal communication between one or more coronary arteries and great vessels or a cardiac chamber. We reviewed 15 cases of CAFs published in PubMed and studied th...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Percutaneous transcatheter closure is the safe and preferred method for anatomic approachable vessels. [2][3][4]8,[14][15][16]…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Diagnosis of Coronary Artery Fistulas: Clinical Aspects and Brief Review of the Literature

2013

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“…Coronary artery fistulas that develop giant aneurysms, as in the present case, are extremely rare . This was the first case to be treated using the minimally invasive method of percutaneous transradial embolization, using a thin guiding catheter.…”

Section: Discussionmentioning

confidence: 58%

Coronary artery fistula with a giant aneurysm treated by percutaneous transradial embolization

Tanabe

Tejima

Sakurada

2012

Cathet Cardio Intervent

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Coronary artery fistulas are rare anomalies that are very rarely accompanied by an aneurysm. The minimally invasive method of percutaneous transradial embolization, using a thin guiding catheter, was used to treat a coronary artery fistula with an associated giant aneurysm. This technique, not previously described for this type of application, is presented as a case report. The successful outcome of this procedure demonstrated that transradial coronary interventions are useful for treating coronary artery fistulas with an associated giant aneurysm, especially in patients at high risk for conventional surgery or transfemoral interventions.

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Multiple coronary to pulmonary artery fistulas: a case report and review of the literature

Taleb

Sheikh

Cooper

et al. 2012

Cardiovasc Interv and Ther

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Coronary to pulmonary artery fistulae (CAF) are rare cardiac anomalies. The majority arise from the right coronary artery, with fistulae originating from the left anterior descending artery or from multiple arteries being less common. CAF are frequently asymptomatic and found incidentally on routine cardiac imaging. We present the case of a 61-year-old woman with multiple CAF who presented with progressive shortness of breath and chest pain and was ultimately treated successfully with trans-catheter coiling with marked improvement in symptoms. We also review the currently available literature regarding advances in diagnosis and treatment of CAF.

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Communicating bilateral coronary artery to pulmonary artery fistula with aneurysm in asymptomatic patient: Successful conservative management with selective coil embolization of the aneurysm

Cited by 7 publications

References 7 publications

Diagnosis of Coronary Artery Fistulas: Clinical Aspects and Brief Review of the Literature

Diagnosis of Coronary Artery Fistulas: Clinical Aspects and Brief Review of the Literature

Coronary artery fistula with a giant aneurysm treated by percutaneous transradial embolization

Multiple coronary to pulmonary artery fistulas: a case report and review of the literature

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