Left circumflex coronary arteriovenous fistula presenting as acute coronary syndrome

Abstract

Coronary arteriovenous fistula (CAVF) is a rare congenital anomaly that is seen in 0.1-0.2% of coronary angiograms. A 79-year-old man with no risk factors for coronary artery disease, presented with unstable angina and normal clinical examination. Coronary angiogram revealed a large left circumflex coronary artery with multiple aneurysms exiting into right atrium. Although coil embolization was feasible, he was managed conservatively as he responded to medications. This case shows that large CAVF can be asymptomatic up to the 7th decade of life, manifest as acute coronary syndrome, can present without any murmur on auscultation, and medical management can be effective.

Giant Circumflex Aneurysm With Arteriovenous Fistula Surgery Guided by Three-Dimensional Printing

“…5 Some patients with CAF exhibit angina, palpitations, thrombosis with local occlusion or distal embolization, vasospasm, or heart failure. 3,4 These 2 coronary irregularities can be congenital or acquired. The most frequent cause is atherosclerosis, but they can be found in collagen vascular diseases, after chest traumas, or as a result of percutaneous interventions.…”

“…2 Indications for closure of CAF include symptoms of myocardial ischemia, positive treadmill test result, perfusion defect on stress myocardial imaging, aneurysmal dilation, mural thrombus, or shunt > 1.5:1. 4 Thus, because of presenting disabling symptoms, a positive stress test result, and a giant aneurysm with fistula, the decision for a surgical treatment was taken.…”

“…CAFs are found in 0.1% to 0.2% of patients undergoing coronary angiography, and they are frequently seen in the right coronary artery, followed by the left anterior descending artery (LAD) and rarely in the circumflex artery. [3][4][5] A 61-year-old woman was referred to our hospital with a clinical history of progressive angina during the previous year. No relevant personal medical history was known.…”