Coronary Artery and Pulmonary Artery Fistula

Abstract

Coronary artery fistula is a rare condition that can be congenital or acquired. Most patients with these anomalies remain asymptomatic, but symptoms and complications may develop with increasing age. We discuss the clinical presentation, diagnostic work-up, and management options for this condition. ( Level of Difficulty: Intermediate. )

Double Trouble: Bilateral Coronary Artery Fistulae - A Case Report

“…Fistulas tend to grow with age and approximately half of these patients subsequently develop cardiovascular symptoms [3]. Larger fistulas draining into relatively low resistance pulmonary circulation, like in CPAFs, can divert significant amounts of diastolic run-off away from coronary arteries to the pulmonary artery [4,5]. The resulting compromise of coronary blood supply and myocardial oxygenation is known as the 'coronary steal phenomenon' as was originally thought to be the case in our patient [5].…”

“…In asymptomatic patients the only potential sign of an underlying CPAF is a continuous cardiac murmur present in 47% of patients and is best auscultated over the second intercostal space of the left sternal edge [1]. Patients with significant left-to-right shunts may present with chest pain, dyspnoea, palpitation and fatigue [3,4]. In severe circumstances, large left-to-right shunts can have deleterious consequences, causing myocardial infarction or chronic ischemia of the territory distal to the fistula and heart failure from pulmonary circuit overload [1].…”

Case report of an acute coronary syndrome in a patient with artery coronary fistulae

“…This contrasts with the recent publication by Sherif et al . 9 who presented a patient with a coronary artery fistula where myocardial ischaemia was not demonstrated, so invasive treatment was not performed. Closure can be achieved either using a percutaneous approach, in cases of less tortuous or shorter courses and single fistulae, 10 or cardiac surgery, demonstrating a similar good prognosis.…”

A Fistula Where? Left Anterior Descending to Pulmonary Artery Fistula

“…Current research shows that this is a rare congenital anomaly [2]. Most patients are asymptomatic and if they are associated with other conditions such as, coronary artery disease or heart failure they may present with symptoms of angina as well as, dyspnea.…”

“…With the advent of computed tomography (CT) angiography 0.9% of individuals have been incidentally diagnosed with a coronary artery fistula. It can cause myocardial ischemia, sudden cardiac death, ischemic cardiomyopathy, papillary muscle rupture, secondary valvular disease, premature atherosclerosis, among others [ 2 ]. Most patients are asymptomatic and if they are associated with other conditions such as, coronary artery disease or heart failure they may present with symptoms of angina as well as, dyspnea.…”