Coronary Artery Fistula‐Associated Endocarditis: Report of Two Cases and a Review of the Literature

Abstract

Coronary artery fistulae (CAF) are rare congenital anomalies and reported to have an incidence of 0.1-0.2% of all coronary angiograms. An association between fistulae and nonatherosclerotic coronary artery aneurysms is even more rare. In childhood, patients are mostly asymptomatic; however, patients older than 20 years old may present with signs of infective endocarditis, myocardial ischemia, congestive heart failure, and aneurysm rupture. CAF are typically identified by coronary angiography; however, there are some limited studies showing that transesophageal echocardiography (TEE) can also be useful in identifying CAF. Here we report two cases of endocarditis secondary to congenital coronary artery fistulae draining into either a cardiac cavity or a coronary sinus, which were detected by TEE. Vegetations were found at the site of the fistulae drainage. Management for young patients is either percutaneous or surgical intervention. For elderly patients with multiple comorbidities, conservative treatment is another option. In these two cases, treating endocarditis with proper antibiotics and supportive treatment, the patients' conditions improved significantly.

Coronary artery fistula with or without aneurysm: A large comparative study

“…This leads to vascular dilation and an increased probability of aneurysm formation [ 15 ]. Besides, congenital CAF is associated with the occurrence of IE, which can be the first clinical manifestation of CAF [ 16 , 17 ]. As such, IE may be both a result of CAF and an etiology of CAF complicated with aneurysm.…”

Case report: Surgical repair for left main coronary artery to right atrium fistula with endocarditis

“…The involvement of the left main coronary artery (LMCA) accounts for only 0.7% of CAFs ( 3 ). Endocarditis of CAFs in the cardiac chambers is extremely rare ( 4 ). Here, a case of a giant CAF connecting the LMCA to the right atrium (RA) with endocarditis was presented.…”

Surgical Repair of Congenital Coronary Artery Fistula With Giant Aneurysm

“…Abnormality of the CA morphology led to a series of complications post CAF closure. This includes thrombosis, myocardial infarction, and cardiac dysfunction [Shah 2016;Yim 2015;Wang 2015]. Also, we could not find any report or data suggesting a guideline for indication or strategy of CA reconstruction.…”