Isolated congenital coronary fistula in adult population: discussion a clinical case and review of current literature

Abstract

We describe a case of a 56 year-old man with a history of chest pain. No evidence of myocardial ischemia or arrhytmias was observed. Echocardiographic examination in Emergency Department evidenced aortic root dilatation. Angio CT excluded aortic dissection. Trans esophageous Echocardiography (TEE) correctly identified an arterial fistula between the right coronary artery and superior vena cava, confirmed by angio CT 3-D reconstruction and coronarography. The definitive diagnosis was made after integrated approach (using TTE, TEE, CT, coronarography). The anatomic features of the fistula and the aortic root were examinated. Actually the patient is being followed with serial clinical and echocardiography examination for monitoring hemodynamic overload by fistula and size of aortic root for potential surgical correction. Current literature for incidence, diagnosis and the treatment of coronary fistulas is discussed.

Prenatal diagnosis of fetal isolated right coronary artery to left ventricle fistula

“…9 Theoretically, the fistula may occur between any coronary artery and any adjacent cardiac chamber and/or great artery. 9 Theoretically, the fistula may occur between any coronary artery and any adjacent cardiac chamber and/or great artery.…”

“…Coronary artery fistula may be caused by the persistence of intramyocardial trabecular communications formed between endothelial cells and blood lacunae which are initially formed in the cardiac venous plexus and later fusing with the epicardial coronary arteries. 9 Theoretically, the fistula may occur between any coronary artery and any adjacent cardiac chamber and/or great artery. The feeding coronary artery/arteries is/are usually unilateral, seldom bilateral, or multilateral in very few cases.…”

“…2012225098), and sponsored by the Science and Technology Agency of Shenyang, China (NO. F16-206-[9][10][11] Coronary artery fistula (CAF) is a rare malformation and is seldom reported during pregnancy. Right coronary artery fistula commonly drains into the right ventricle, right atrium, or pulmonary artery.…”

Right coronary artery–right ventricular fistula complicated with infective endocarditis

“…CAF occurs in only 0.002% of the general population and accounts for 0.2% to 0.4% of all congenital cardiovascular diseases . In embryology, the etiology is due to the persistence of intramyocardial trabecular connections which are formed by endothelial cells and blood lacunae . Long‐term complications include myocardial ischemia, shunt‐induced heart failure, and infective endocarditis.…”

“…1 In embryology, the etiology is due to the persistence of intramyocardial trabecular connections which are formed by endothelial cells and blood lacunae. 2 Long-term complications include myocardial ischemia, shunt-induced heart failure, and infective endocarditis. In adults, the most common symptoms are chest pain and dyspnea.…”