Coronary artery fistulas: Clinical and therapeutic considerations

Gowda, Ramesh M.; Vasavada, Balendu C.; Khan, Ijaz A.

doi:10.1016/j.ijcard.2005.01.067

Cited by 341 publications

(396 citation statements)

References 50 publications

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“…Over 90% of the fistulas drain into the venous circulation. Small, asymptomatic fistulas have been seen to arise much more commonly from the left coronary system (87%) [4]. Low-pressure structures are the most common sites of drainage of the coronary fistula.…”

Section: Discussionmentioning

confidence: 99%

Multiple left anterior descending coronary artery to left ventricular fistula – A case series and literature review

Iyer

Yelisetti

2017

Journal of Community Hospital Internal Medicine Perspectives

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Coronary artery fistulas (CAFs) are found in 0.3–0.8% of patients who undergo coronary angiography. CAFs are defined as single or multiple, small or large direct communications that arise from one or more coronary arteries and enter into one of the four cardiac chambers or major vessels. We present two cases of multiple coronary artery fistulas arising from diagonal and left anterior descending (LAD) branches of left coronary artery draining into the left ventricle. In both the cases, No intervention was performed. Of the congenital fistulas, two major groups are identified: solitary CAFs or coronary artery-left ventricular multiple micro-fistulas (CALVMMFs). Noninvasive techniques such as transthoracic echocardiography, transesophageal echocardiography and magnetic resonance imaging are becoming increasingly popular for diagnosis and follow-up of CAFs. Despite the advent of these newer non-invasive modalities, coronary angiography remains the gold standard for diagnosis. Treatment of CAFs is indicated when the patients are symptomatic with left ventricular volume overload, myocardial ischemia, left ventricular dysfunction or in the presence of a large or increasing left-to-right shunt. If the fistula is small and hemodynamically insignificant, it can be managed with conservative management. Multiple left anterior descending to left ventricle (LV) fistulas are extremely rare and, as per our literature review, we noted only a few case reports of coronary artery fistulas between branches of LAD and left ventricle.

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Section: Discussionmentioning

confidence: 99%

Multiple left anterior descending coronary artery to left ventricular fistula – A case series and literature review

Iyer

Yelisetti

2017

Journal of Community Hospital Internal Medicine Perspectives

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“…Los síntomas más comunes que se presentan en esta anormalidad son disnea y dolor toráci-co 13,15,21 , y estos síntomas suelen ocurrir en fís-tulas de tamaño grande al menos, como nuestra paciente que consultó por disnea de esfuerzo. El diagnóstico preliminar de esta entidad suele plantearse ante la presencia de un soplo cardíaco, el cual se describe en 82%, en los pacientes adultos que han llegado a estudio 15 , y se puede confirmar con un ecocardiograma, especialmente en edad pediátrica, pero también en pacientes adultos 2,3 .…”

Section: Discussionunclassified

“…El diagnóstico preliminar de esta entidad suele plantearse ante la presencia de un soplo cardíaco, el cual se describe en 82%, en los pacientes adultos que han llegado a estudio 15 , y se puede confirmar con un ecocardiograma, especialmente en edad pediátrica, pero también en pacientes adultos 2,3 . La necesidad de angiografía en el estudio es más bien para delinear la verdadera anatomía y definir las alternativas terapéuticas en el paciente 2,14,15,21 , aunque en el adulto puede ser requerida como método diagnostico, en nuestro caso el ecocardiograma sugirió el diagnóstico y la angiografía lo confirmó. También, en el último tiempo, el diagnóstico puede también ser confirmado por tomografía coronaria 22 .…”

Section: Discussionunclassified

“…Otros opinan lo contrario 2,3,21 , de acuerdo con lo propuesto por las guías de manejo de las cardiopatías congénitas publicadas por la sociedad americana de cardiología 24 , que preconiza el cierre de fístulas sintomáticas o que produzcan alguna complicación y las fístulas grandes, independiente de su sintomatología. En este caso en particular, con una fístula muy grande y sintomática está claramente indicado su cierre.…”

Section: Discussionunclassified

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Fístula coronaria gigante. Presentación clínica, caracterización angiográfica, tratamiento y seguimiento a largo plazo: Caso clínico

Ugalde

Dussaillant

2016

Rev. méd. Chile

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“…Clinical man ifestations vary considerably and as it was mentioned above the patients with coronary fistulas may present with dyspnea, congestive heart failure, angina, endocarditis, arrhythmias, angina or myocardial infarct ion, but a majority of patients are asymptomat ic as fistulas cause myocardial ischemia only in a s mall number o f them. A continuous murmur heard at the upper sternum border is often presented and is highly suggestive of a coronary fistula Differential diagnosis includes persistent ductus arteriosus, pulmonary arteriovenous fistula, ruptured sinus of Valsalva aneurysm, aortopulmonary window, p rolapse of the right aortic cusp with a supracristal ventricular septal defect, internal mammary artery to pulmonary artery fistula, and systemic arteriovenous fistula [6].…”

Section: Discussionmentioning

confidence: 99%

An Unusual Presentation of Coronary Artery Fistula in Athlete - Case Report

Kisko¹,

Derňárová²,

Kmeč³

et al. 2012

CMD

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A 32-year-old active cyclist was referred fo r the evaluation because of syncope he had performed in preseason.He was found to be normostenic, acyanotic, normotensive with clear lungs and a regular pulse of 60 bp m, with normal dual heart sounds and a grade Levine 2/6 continuous diastolic murmu r in the second intercostal space of the left parasternal area. He had no family history of premature card iac death and his lipids were normal. Rest ECG showed a regular sinus rhythm of 62 bp m with inco mplete right bundle branch block and no significant ST-T changes. A transthoracic ECHO in parasternal short-axis view revealed an anomalous colour flow jet in diastole arising fro m the lateral wall into the main pulmonary artery and coronary artery fistula with non-significant left -to-right shunt (Qp/Qs ratio 1.2).came under suspicion. In contrast, it has not been confirmed clearly by the transoesophageal ECHO. Coronary angiography was without coronary stenosis and confirmed a 'serpentine' anomalous drainage supposedly from left anterior descending artery to the main pulmonary artery. A complex anato my of sacculary dilated fistula that originates fro m the pro ximal left anterio r descending artery and drainages the main pulmonary artery was showed in detail by a 64 slice MDCT scanning. Myocardial Tc-99m Myoview perfusion SPECT imag ing showed no perfusion defects in maximal physical stress and follo w-up without intervention was suggested. In addition, due to the results of holter ECG monitoring, head-up tilt testing, carotid sinus massage and programmed atrial stimulat ion syncope was concluded as vasovagal, but its nature still remains discussible. After a three year follow-up patient remains asympto matic and recently performed control myocardial perfusion SPECT showed no signs of stress related myocardial ischemia. In conclusion, several imaging techniques are needed for an accurate diagnosis of coronary fistula and for the suggestion of proper further management. In some cases syncope may be the first man ifestation of CAF, but it is still unclear if it is directly related to the coronary anomaly.

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Coronary artery fistulas: Clinical and therapeutic considerations

Cited by 341 publications

References 50 publications

Multiple left anterior descending coronary artery to left ventricular fistula – A case series and literature review

Multiple left anterior descending coronary artery to left ventricular fistula – A case series and literature review

Fístula coronaria gigante. Presentación clínica, caracterización angiográfica, tratamiento y seguimiento a largo plazo: Caso clínico

An Unusual Presentation of Coronary Artery Fistula in Athlete - Case Report

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