Coronary artery fistula presenting as bacterial endocarditis

Kasravi, Babak; Reid, Carolina; Allen, Byron J.

doi:10.1016/j.echo.2004.06.028

Cited by 19 publications

(30 citation statements)

References 10 publications

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“…All had CCFs where fistulas arose from right or left coronary arteries having a unilateral [1,[38][39][40][41] or bilateral [1,42] origin. The termination site was always a cardiac chamber either right-or left-sided: RA [38,41] , RV [1] , CS [39,40,42,43] or LA [1] . Streptococcus [38,42,44] and Staphylococcus species [40] were isolated from blood cultures.…”

Section: Iementioning

confidence: 99%

“…The termination site was always a cardiac chamber either right-or left-sided: RA [38,41] , RV [1] , CS [39,40,42,43] or LA [1] . 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.…”

Section: Iementioning

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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Section: Iementioning

confidence: 99%

Section: Iementioning

confidence: 99%

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

Saïd

2011

WJC

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“…10) To our knowledge, only 8 cases of fistulous connection of an aneurysmal circumflex coronary artery to the coronary sinus have been previously described in the English literature (Table). [3][4][5][6][7][8] The optimal therapeutic strategy for CAF is not clearly established. Although it is evident that surgical intervention is necessary for symptomatic patients, those with complications, and those with a significant shunt (Qp/Qs > 2.0), the indications for surgical intervention in asymptomatic patients with no or only mild shunting are still controversial, because of the great variability in the natural history.…”

Section: Discussionmentioning

confidence: 99%

“…2) Among various coronary artery anomalies, fistulous connection of the aneurysmal circumflex coronary artery to the coronary sinus has been previously reported as an extremely uncommon form. [3][4][5][6][7][8] In this paper, we describe a case of an aneurysmal circumflex artery connecting to the coronary sinus through a fistula, and discuss surgical management for patients with CAF, particularly for asymptomatic patients with a small left-toright shunt.…”

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confidence: 99%

Coronary Artery Fistula From the Left Circumflex to the Coronary Sinus

et al. 2006

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SUMMARYA 27-year-old woman, who had received mitral valve repair for mitral regurgitation resulting from infective endocarditis, was admitted for a close examination of abnormal echocardiographic findings in the left atrium. Transthoracic echocardiography showed trivial mitral regurgitation with normal left ventricular contraction and dilatation of the coronary sinus. Auscultation revealed a grade 2 continuous murmur along the left sternal border. Transesophageal echocardiography demonstrated a marked dilatation of the coronary sinus just behind the posterior wall of the left atrium and turbulent blood flow in the dilated coronary sinus. Cardiac catheterization showed no significant step-up of oxygen saturation in the right heart and normal pulmonary artery pressure. Coronary angiography revealed a markedly dilated and tortuous circumflex coronary artery connected to the coronary sinus through a fistula. A left circumflex artery with a fistulous connection to the coronary sinus is extremely rare. (Int Heart J 2006; 47: 147-152) Key words: Coronary artery fistula, Coronary artery aneurysm, Circumflex coronary artery, Coronary sinus CORONARY artery fistula (CAF) is a rare congenital anomaly with a reported incidence of 0.1% to 0.2% in the adult population referred for cardiac catheterization.1) Fistulous connection into a cardiac chamber or major vessel often causes a marked dilation of the donor coronary artery leading to aneurysm formation. 2)Among various coronary artery anomalies, fistulous connection of the aneurysmal circumflex coronary artery to the coronary sinus has been previously reported as an extremely uncommon form. [3][4][5][6][7][8] In this paper, we describe a case of an aneurysmal circumflex artery connecting to the coronary sinus through a fistula, and discuss surgical management for patients with CAF, particularly for asymptomatic patients with a small left-toright shunt.From the

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“…Infective endocarditis is a less frequent complication [6] . There are multiple case reports confirming these symptoms on stress testing and even event monitoring [7] .…”

Section: Introductionmentioning

confidence: 99%

Coronary artery fistulas: A case presentation and literature review

Chou

Silvet²,

Tyagi³

2014

CRIM

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Coronary fistulas are rare anomalies that connect the coronary artery to either a cardiac chamber (coronary cameral fistula) or vein (arteriovenous fistula). They arise due to abnormalities in embryologic development and are often coincidental findings. The exact incidence is estimated to be between 0.1-0.2 percent of the general population. There are no consensus guidelines for management of these fistulas. We present a patient with a large fistula and will review the literature and management decisions for this clinical abnormality.A 66-year-old man with diabetes, hypertension and a prior bioprosthetic aortic valve presented to the Loma Linda VA Hospital with shortness of breath. An echocardiogram revealed moderate to severe prosthetic aortic stenosis, and an angiogram showed 80% mid left anterior descending (LAD) obstruction with a large arteriovenous fistula. The fistula extended from the circumflex artery to coronary sinus. He was referred for redo open heart surgery with aortic valve replacement, coronary bypass grafting and repair of the fistula.There are multiple case reports of these malformations causing symptoms of angina, coronary steal or heart failure based on various testing modalities. However, in 31 individuals with incidental findings of coronary fistulas from a small case series, no adverse effects on cardiac function were noted based on physical exam or functional testing. If treatment is deemed beneficial, surgery is the most available option and another study of 41 symptomatic patients reported low post-operative morbidity and mortality after nine-year follow-up.The authors believe that large fistulas found incidentally should be further evaluated for ischemia and monitored for symptoms. For individuals with small fistulas, conservative management is a viable strategy as there is a high incidence of spontaneous closure. If a fistula is determined to be symptomatic, operative repair is well tolerated.

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Coronary artery fistula presenting as bacterial endocarditis

Cited by 19 publications

References 10 publications

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

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

Coronary Artery Fistula From the Left Circumflex to the Coronary Sinus

Coronary artery fistulas: A case presentation and literature review

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