Histopathologic Characteristics of a Coronary-pulmonary Artery Fistula with a Coronary Artery Aneurysm

Abstract

Here, we report a case of a 59-year-old woman with a coronary-pulmonary artery fistula with a concomitant coronary artery aneurysm, which comprised an anomalous coronary artery originating at the right coronary cusp, an aberrant branch of the left anterior descending artery, and a coronary artery aneurysm draining into the main pulmonary artery. Histopathologically, non-dilated anomalous coronary artery showed the preservation of internal elastic lamina and medial smooth muscle cell phenotype which lacked in the aneurysmal wall. Thus, the disrupted internal elastic lamina and phenotypic change of medial smooth muscle cells might contribute to aneurysm formation in a coronary-pulmonary arterial fistula.

Congenital coronary artery-to-pulmonary fistula with giant aneurysmal dilatation and thrombus formation: a case report and review of literature

“…(2) Exploring pertinent etiologies is necessary. According to other cases, Degenerated media and smooth muscle layer, suggested by the patient's pathology report, could be attributed to the occurrence of aneurysmal dilatation [19,20].…”

Interventricular septal dissecting aneurysm resulting from congenital coronary fistula: A case report

“…5 Coronary artery fistula can originate from the RCA or the left coronary artery or its branches, but reports show that it most commonly originates from the RCA (55%), with 35% from the left coronary artery and 5% from both coronary arteries. 6 The coronary artery can drain into any cardiac chamber or a large vascular structure. However, the most common site of drainage is the right ventricle.…”

“…Coronary artery fistula can originate from the RCA or the left coronary artery or its branches, but reports show that it most commonly originates from the RCA (55%), with 35% from the left coronary artery and 5% from both coronary arteries 6 …”

Histopathology of Giant Coronary Artery Aneurysm Associated with Coronary Artery Fistula

“…These histological findings have not been reported in patients with giant coronary artery aneurysm associated with coronary fistula. However, Sakata, et al 19) suggested that a structural change of the CAF such as disrupted internal elastic lamina and phenotypic changes of the medial smooth muscle cells might contribute to aneurysmal formation (7-8 mm in diameter) in a patient with coronary-pulmonary arterial fistula. Thus, wall weakness related to medial degeneration in addition to a lack of internal and (or) external elastic lamina of the CAF conduit may have contributed to the development of the giant aneurysm in the present patient.…”