Giant coronary artery fistula: A case report

Trang, Pham-Thi Thao; Cuong, Tran Chi; Cuong, Nguyen Manh; Tin, Do Nguyen; Tran Tran, Nguyen; Thang, Le Minh; Hoa, Tran; Dung, Bui The; Hieu, Tran Ba; Duc, Nguyen Minh

doi:10.1016/j.radcr.2023.05.003

Cited by 1 publication

(7 citation statements)

References 12 publications

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“…In our case, the RCA was dilated to about 7.8 mm, the left coronary artery measured 3.4 mm, and there was an abnormal shunt into the LV near the base of the mitral valve. Our previous case also had the same result: the proximal RCA was dilated to 18.6 mm and accompanied by an aneurysm in the middle RCA (30 mm) and a two-way fistula into the right atrium; the left-main coronary artery was normal with a diameter of about 3 mm ( 7 ). Indirect signs in echocardiograms associated with changing heart structure include the ejection fraction, dilated LV, mitral valve regurgitation by annulus dilatation, tricuspid valve regurgitation, and pulmonary arterial pressure increasing ( 7 ).…”

Section: Discussionsupporting

confidence: 67%

“…Our previous case also had the same result: the proximal RCA was dilated to 18.6 mm and accompanied by an aneurysm in the middle RCA (30 mm) and a two-way fistula into the right atrium; the left-main coronary artery was normal with a diameter of about 3 mm ( 7 ). Indirect signs in echocardiograms associated with changing heart structure include the ejection fraction, dilated LV, mitral valve regurgitation by annulus dilatation, tricuspid valve regurgitation, and pulmonary arterial pressure increasing ( 7 ). Many noninvasive techniques exist to diagnose and follow up CAFs, such as transthoracic echocardiogram, transesophageal echocardiogram, and magnetic resonance imaging.…”

Section: Discussionsupporting

confidence: 67%

“…While our patient’s electrocardiogram showed sinus rhythm without pathological Q waves, ST segment, or T wave changes, our previous case had tachycardia and block A-V type 1 ( 7 ). Generally, electrocardiograms are unhelpful and are used to differentially diagnose other conditions, such as myocardial ischemia, myocardial infarction, and arrhythmias ( 5 ).…”

Section: Discussioncontrasting

confidence: 47%

“…A CAF into the left heart chamber (i.e., left-to-left shunt) led to a large left heart volume and an increased LV pressure in our previous case, with the last consequence being LV hypertrophy ( 12 ). In contrast, in another previous case, a CAF into the right heart chamber (i.e., left-to-right shunt) led to increased right heart volume, tricuspid valve regurgitation, and pulmonary artery hypertension ( 7 ). Most coronary fistulas are asymptomatic and detected incidentally.…”

Section: Discussionmentioning

confidence: 69%

“…He had coronary artery disease symptoms and risk factors (hypertension and smoking). Our previous case report detailed a 35-year-old woman who developed symptoms after her second pregnancy, which made us misunderstand the other disease relating to peripartum cardiomyopathy ( 7 ). In all the above cases, CAFs are difficult to diagnose and can be missed.…”

Section: Discussionmentioning

confidence: 99%

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A Complicated Case Report of Coronary Artery Fistula

Trang,

Cuong,

Tha

et al. 2023

Med Arch

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Background: Coronary artery fistulas (CAFs), also, known as coronary arteriovenous malformation, are aberrant connections between coronary arteries and other structures, such as other artery branches or heart chambers. CAFs are infrequent and asymptomatic in young patients, but symptoms and complications become more frequent with age. CAFs can affect hemodynamic parameters and lead to complications, such as myocardial ischemia, heart failure, arrhythmia, and infective endocarditis. Objective: The aim of this article was to present a typical CAF case with severe symptoms who underwent successful embolization to resolve their symptoms. Case presentation: A 50-year-old Vietnamese male visited our cardiac outpatient clinic (S.I.S General Hospital, Can Tho, Vietnam) because of exertional dyspnea and chest pain. Signs of congestive heart failure and abnormal murmur were not presented on chest auscultation. Diagnostic digital subtraction angiography was performed to determine the detailed angioarchitecture of the CAF, revealing a fistulous connection between the left anterior descending artery (LAD) and the LV chamber through an aneurysm. In addition, the RCA measured 7 mm in diameter with a fistula (16 × 9 mm) draining into an aneurysm and then terminating into the LV chamber. The patient had an RCA aneurysm with a fistula into the LV. It was treated successfully by closing the fistula with a vascular plug. Access to the fistula was complex and difficult because of complications due to the CAF. After the procedure, the patient had no chest pain or shortness of breath and was discharged after three days. After six months, he was taking dual antiplatelet therapy and antihypertensive medications and felt better. We performed contrast computed tomography (CT) to examine the fistula after a year, which showed the successful closure of the fistula without any relevant alteration in the coronary artery. Conclusion: CAF closure is indicated if patients have symptoms or secondary complications, and percutaneous closure is a safe and effective method to manage CAF. A CAF is rare and does not have specific symptoms, making it difficult to diagnose. Most patients are asymptomatic and have serious recent complications. Currently, the percutaneous transcatheter method is popular because it is noninvasive and successful in most patients.

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Section: Discussionsupporting

confidence: 67%

Section: Discussionsupporting

confidence: 67%