Large coronary pseudoaneurysm with pulmonary artery fistula, six months after left main trunk stenting with paclitaxel-eluting stent

Abstract

There are no reported cases of a pseudoaneurysm leading to a fistula into the pulmonary artery after percutaneous coronary intervention. We describe a patient who developed a late pseudoaneurysm after left main trunk (LMT) stenting with paclitaxeleluting stent, discovered during coronary angiography. Transesophageal echocardiography and contrast-enhanced computed tomographic scan revealed a pericardial effusion, a large pseudoaneurysm communicating with LMT and a fistula into the pulmonary artery. The recommended therapy was surgery.

Unilateral and Multilateral Congenital Coronary‐Pulmonary Fistulas in Adults: Clinical Presentation, Diagnostic Modalities, and Management With a Brief Review of the Literature

“…Coronary‐pulmonary fistulas are generally congenital in origin, but acquired fistulas subsequent to penetrating or nonpenetrating chest traumas have been reported. Furthermore, although rare, they may be acquired late secondary to iatrogenic nonsurgical interventions such as PCI and following endomyocardial biopsy or after CABG . Among our present case series, CPFs were found in 11 and solitary CCFs in 3 of the subjects, with the vast majority as unilateral (10/14, 71%) and multilateral (4/14, 29%) fistulas.…”

“…The overwhelming majority of CPFs are congenital in origin, as was the case in our current series, but acquired fistulas subsequent to penetrating or nonpenetrating chest traumas have been reported. Furthermore, acquired CPFs have been reported as a late complication after stenting of the left main trunk with a paclitaxel‐eluting stent and secondary to CABG occurring between the left internal mammary artery graft and the PA, which give rise to the recurrence of angina and occurrence of a novel cardiac murmur . Recently, optical coherence tomography revealed the cause of an acquired fistula as a spontaneous rupture of a subadventitial hematoma of the RCA communicating with the lumen of the right cardiac chambers …”

“…Congenital coronary‐pulmonary fistulas (CPFs) were first described postmortem in an adult male by Krause in 1865 . CPFs may rarely be acquired subsequent to iatrogenic nonsurgical intervention and surgical procedures, or due to accidental thoracic traumas . Congenital unilateral or multilateral CPFs are increasingly recognized during routine coronary angiography (CAG) or multidetector computed tomography (MDCT) for analysis of chest pain, but remain uncommon anomalies, characterized by a communication between 1 or more coronary arteries and the pulmonary artery.…”

Successful sparing approach between the ascending aorta and the main pulmonary artery to the giant coronary aneurysm of the left main coronary artery

“…Only few studies have reported an aneurysm originating from the LMT after catheter treatment or surgery. 13 However, in the present case, the patient had not undergone previous catheter examination or treatment. History and clinical observations during the surgery strongly suggested pseudoaneurysm due to atherosclerosis.…”

Systematic review of the evaluation and management of coronary pseudoaneurysm after stent implantation

“…Pseudoaneurysm (PSA) formation is a rare but well‐known complication of coronary stenting 1‐36 . It develops after a perforation disrupts the integrity of the vessel wall but is contained by extravascular thrombosis, fibrosis, and pericardial constraint.…”