Coronary Artery Fistula From the Left Circumflex to the Coronary Sinus

Aoyagi, Shigeaki; Fukunaga, Shuji; Ishihara, Kenji; Egawa, Noriko; Hosokawa, Yukio; Nakamura, Eiji

doi:10.1536/ihj.47.147

Cited by 18 publications

(17 citation statements)

References 16 publications

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“…d The right anterior oblique (RAO) view of the left coronary angiogram shows a dilated tortuous LAD and its branches, and especially the septal branch (gray arrow), draining into the right ventricle with formation of a septal aneurysm (*). e The LAO view of the right coronary angiogram shows a plexus of fine tortuous vessels supplied by the right side coronary arteries, but it fails to clearly demonstrate the complex vascular relationships b [22][23][24]. Our case showed the large coronary sinus aneurysm in association with a fistulous connection between the three main coronary arteries and the coronary sinus (Fig.…”

Section: Coronary Artery To Coronary Sinus Fistulamentioning

confidence: 82%

Complex coronary artery fistulas in adults: evaluation with multidetector computed tomography

Seon

Kim

Choi

et al. 2010

Int J Cardiovasc Imaging

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Coronary artery fistulas (CAFs) are rare congenital or acquired abnormalities that have anomalous terminations of the coronary arteries. Although many patients with CAFs are asymptomatic, they can display various clinical features associated with ischemic heart disease or heart failure. Making an early diagnosis is important for the proper management and prevention of late symptoms and complications. Conventional coronary angiography and cardiac CT have been commonly performed to diagnose CAFs, but multi-detector computed tomography (MDCT) is now being widely applied for diagnosing cardiovascular anomalies, and the number of incidentally detected CAFs on MDCT has been increasing. Therefore, we have to be familiar with the image findings of CAFs, and especially the image findings of MDCT for making the correct diagnosis of CAFs. In this article, we illustrate the MDCT findings of various types of CAFs in adults and we review the pathophysiology and clinical features of CAFs.

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Section: Coronary Artery To Coronary Sinus Fistulamentioning

confidence: 82%

Complex coronary artery fistulas in adults: evaluation with multidetector computed tomography

Seon

Kim

Choi

et al. 2010

Int J Cardiovasc Imaging

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“…Streptococcus [38,42,44] and Staphylococcus species [40] were isolated from blood cultures. Echocardiography demonstrated aneurysmal dilatation of the donor vessels [43][44][45] , and recipient chamber [42,45] , and valvular [44,45] and non-valvular [42,44] vegetation. Furthermore, there was moderate and severe valvular regurgitation with ruptured chordae [1,39] .…”

Section: Iementioning

confidence: 99%

“…Non-valvular vegetation was located in the inferior atriocaval junction [38] and CS [40,42,44] . Turbulent flow in the recipient chamber was noted by color Doppler [40,45] . Associated congenital and acquired heart defects (single coronary artery, bicuspid aortic valve and atrio-ventricular valvular heart disease) were also visualized [1,2,41] .…”

Section: Iementioning

confidence: 99%

“…Furthermore, turbulent blood flow may be seen in the dilated recipient cardiac chamber [2] . In cases of IE associated with CAFs, valvular [44,45] and non-valvular [42,44] vegetations have been described. Echocardiographic examination showed a variety of associated congenital and acquired heart defects [2,3,51,80] .…”

Section: Abnormal Shadow On Chest X-raymentioning

confidence: 99%

“…Cx fistulas terminated into the PA in (23%) [47,104] , but the majority ended in the CS in 40% [43,[105][106][107][108][109] and the RA in 15% [73,78,110] of cases. The clinical presentations consisted of dyspnea [111,112] , palpitations [69,81] , syncope [83] , angina pectoris [113,114] , chest pain [84] , fatigue [66,115] , CHF [45] and IE [39,40,43] . The termination of RCA fistulas was variable: RA 26%, RV 25%, PA 16%, CS 11%, left LV 12%, LA 3%, SVC 5%, RVOT 1% and PV 1% [33,41,72,70,110,116] .…”

Section: Abnormal Shadow On Chest X-raymentioning

confidence: 99%

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Current characteristics of congenital coronary artery fistulas in adults: A decade of global experience

Saïd

2011

WJC

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AIM:To describe the characteristics of coronary artery fistulas (CAFs) in adults, including donor vessels and whether termination was cameral or vascular. METHODS:A PubMed search was performed for articles between 2000 and 2010 to describe the current characteristics of congenital CAFs in adults. A group of 304 adults was collected. Clinical data, presentations, diagnostic modalities, angiographic fistula findings and treatment strategies were gathered and analyzed. With regard to CAF origin, the subjects were tabulated into unilateral, bilateral or multilateral fistulas and compared. The group was stratified into two major subsets according to the mode of termination; coronary-cameral fistulas (CCFs) and coronary-vascular fistulas (CVFs). A comparison was made between the two subsets. Fistula-related major complications [aneurysm formation, infective endocarditis (IE), myocardial infarction (MI), rupture, pericardial effusion (PE) and tamponade] were described. Coronary artery-ventricular multiple micro-fistulas and acquired CAFs were excluded as well as anomalous origin of the coronary arteries from the pulmonary artery (PA). RESULTS:A total of 304 adult subjects (47% male) with congenital CAFs were included. The mean age was 51.4 years (range, 18-86 years), with 20% older than 65 years of age. Dyspnea (31%), chest pain (23%) and angina pectoris (21%) were the prevalent clinical presentations. Continuous cardiac murmur was heard in 82% of the subjects. Of the applied diagnostic modalities, chest X-ray showed an abnormal shadow in 4% of the subjects. The cornerstone in establishing the diagnosis was echocardiography (68%), and conventional contrast coronary angiography (97%). However, multislice detector computed tomography was performed in 16%. The unilateral fistula originated from the left in 69% and from the right coronary artery in 31% of the subjects. Most patients (80%) had unilateral fistulas, 18% presented with bilateral fistulas and 2% with multilateral fistulas. Termination into the PA was reported in unilateral (44%), bilateral (73%) and multilateral (75%) fistulas. Fistulas with multiple origins (bilateral and multilateral) terminated more frequently into the PA (29%) than into other sites (10.6%) (P = 0.000). Aneurysmal formation was found in 14% of all subjects. Spontaneous rupture, PE and tamponade were reported in 2% of all subjects. In CCFs, the mean age was 46.2 years whereas in CVFs mean age was 55.6 years (P = 0.003). IE (4%) was exclusively associated with CCFs, while MI (2%) was only found in subjects with CVFs. Surgical ligation was frequently chosen for unilateral (57%), bilateral (51%) and multilateral fistulas (66%), but percutaneous therapeutic embolization (PTE) was increasingly reported (23%, 17% and 17%, respectively). CONCLUSION:Congenital CAFs are currently detected in elderly patients. Bilateral fistulas are more frequently reported and PTE is more frequently applied as a therapeutic strategy in adults.

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Coronary Arterial Fistula

2009

The Natural and Unnatural History of Congenital Heart Disease

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Congenital coronary artery fistula is a rare abnormality in which a branch of either coronary artery communicates with a cardiac chamber or with the pulmonary trunk. Recently Papaioannou and his colleagues (1962) reviewed 70 adequately documented cases, including one of their own; in 18 of these a branch of the right coronary artery entered the right ventricle. A further patient with this anomaly is described here, with observations on the problem of diagnosis and a possible surgical approach to the correction of the lesion. Case ReportA man, aged 31 when he died, was first seen at this hospital in 1957 six years previously, when he was admitted for a hernia operation. He had been attending a physician elsewhere and was known to have congenital heart disease, which was then symptomless. At no time did he have a continuous murmur.On examination, he had a collapsing pulse with capillary pulsation and a wide pulse pressure (blood pressure 150/45 mm. Hg). There was no cyanosis or clubbing and the venous pressure was normal. The heart was very large with hypertrophy of both ventricles. There was a very loud pan-systolic murmur, with thrill, maximal in the third intercostal space to the left of the sternum, an apical mid-diastolic murmur, and a soft blowing early-diastolic murmur down the left border of the sternum. The second sound was normally split. The electrocardiogram showed left ventricular hypertrophy, without ST or T wave changes but with notching of the R wave in leads I and V6 (Fig. la). On the chest radiograph there was enlargement of aorta and pulmonary trunk, and considerable pulmonary plethora. At cardiac catheterization, a large left-toright shunt at ventricular level was demonstrated (pulmonary/systemic flow ratio approximately 4:1), the pulmonary arterial pressure was slightly raised (35/7 mm. Hg above the sternal angle), and the pulmonary vascular resistance was normal. He was thought to have a ventricular septal defect with aortic regurgitation, but the discrepancy between the width of the pulse pressure and the inconspicuous early diastolic murmur was noted. Operation was not advised as he was then symptomless and as the presence of presumably free aortic reflux would have posed problems which at that time were insuperable.He was not seen again until five years later when he returned with increasing effort dyspncea and palpitation, and was found to have atrial fibrillation, with clinical and radiological evidence of pulmonary congestion. The signs were otherwise unchanged (phonocardiogram shown in Fig. lc), but the electrocardiogram now showed evidence of right ventricular hypertrophy (Fig. lb). The blood pressure was 170/30 mm. Hg. In spite of treatment his condition deteriorated, and he was readmitted to hospital with right and left ventricular failure, pulmonary infarction, and secondary chest infection. He never improved sufficiently for further investigations to be undertaken, and he died in May 1963.At necropsy (Dr. W. J. Hanbury) there was peripheral cedema, with pleural, pericardial, and p...

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Coronary Artery Fistula From the Left Circumflex to the Coronary Sinus

Cited by 18 publications

References 16 publications

Complex coronary artery fistulas in adults: evaluation with multidetector computed tomography

Complex coronary artery fistulas in adults: evaluation with multidetector computed tomography

Current characteristics of congenital coronary artery fistulas in adults: A decade of global experience

Coronary Arterial Fistula

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