Sequential moderate coronary artery fistula and moderate coronary artery stenosis causing ischemia demonstrated by fractional flow reserve and relieved following percutaneous coronary intervention

Hollenbeck, Ryan D.; Salloum, Joseph

doi:10.1002/ccd.25170

Cited by 8 publications

(5 citation statements)

References 16 publications

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“…Some cases of FFR use to assess the functional severity of the CAF alone or in combination with coexisting de novo mild to moderate coronary lesions have been reported. 6 , 7 A low FFR indicates the presence of myocardial ischemia associated with anatomically normal vessels. At maximum hyperemia, a coronary steal phenomenon can be manifested, especially if the donor vessel supplies the territory of a dominant vessel.…”

Section: Discussionmentioning

confidence: 99%

Transcatheter Occlusion of Coronary-Pulmonary Fistula With a Liquid Embolic Agent After Evaluation by FFR

et al. 2022

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Section: Discussionmentioning

confidence: 99%

Transcatheter Occlusion of Coronary-Pulmonary Fistula With a Liquid Embolic Agent After Evaluation by FFR

et al. 2022

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“…FFR increased from 0.78 to 0.95 when subsequently treated with PTE. On the other hand, Hollenbeck and Salloum reported a case of anterior wall ischemia, proven by MPI to be caused by a moderate LAD stenosis, and bilateral CPFs where FFR improvement occurred following stenting of the LAD lesion alone . On the contrary, in CCFs (solitary CCFs or coronary artery‐ventricular MMFs), FFR revealed normal hemodynamic parameters ruling out ischemia or a steal phenomenon …”

Section: Discussionmentioning

confidence: 99%

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

Saïd

Nijhuis

Akker

et al. 2014

Clinical Cardiology

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Background: Congenital coronary-pulmonary fistulas (CPFs) are commonly unilateral, but bilateral and multilateral fistulas may occur. In multilateral CPFs, the value of a multidetector computed tomography (MDCT) imaging technique as an adjuvant to coronary angiography (CAG) is eminent. The purpose of this study was to describe the clinical presentation, diagnostic modalities, and management of coincidentally detected congenital CPFs. Hypothesis: Unilateral and multilateral coronary-pulmonary fistulas are increasingly detected due to the wide speard application of multidetector computed tomography which might be a supplementary or replacing to conventional coronary angiography. Methods: We evaluated 14 adult patients with congenital coronary artery fistulas (CAFs) who were identified from several Dutch cardiology departments. Results: Fourteen adult patients (5 female and 9 male), with a mean age of 57.5 years (range, 24-80 years) had the following abnormal findings: audible systolic cardiac murmur (n = 4), chronic atrial fibrillation (n = 2), nonsustained ventricular tachycardia (n = 1), and cardiomegaly on chest x-ray (n = 2). Echocardiography revealed normal findings with trivial valvular abnormalities (n = 9), depressed left ventricle systolic function (n = 3), and severe mitral regurgitation and atrial dilatation (n = 2). The findings in the rest of the patients were unremarkable. CAG and MDCT were used as a diagnostic imaging techniques either alone (CAG, n = 6; MDCT, n = 1) or in combination (n = 7). Single modality and multimodality diagnostic methods revealed 22 fistulas including CPFs (n = 15), coronary cameral fistulas terminating into the right (n = 2) and the left atrium (n = 1), and systemic-pulmonary fistulas (n = 4). Of all of the fistulas, 10 were unilateral, 6 were bilateral, and 6 was hexalateral.13 N-ammonia positron emission tomography-computed tomography was performed in 3 patients revealing decreased myocardial perfusion reserve. Conclusions: CAG remains the gold standard for detection of CPFs. An adjuvant technique using MDCT provides full anatomical details of the fistulas.The authors have no funding, financial relationships, or conflicts of interest to disclose.

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“…In fact, our case is preceded by other reported cases of FFR use to assess the functional severity of the CAF alone or in combination with co-existing de novo mild-moderate coronary lesion [3–6]. Thus, the use of FFR to interrogate the functional significance of coronary fistula is not new.…”

mentioning

confidence: 77%

“…Thus, the use of FFR to interrogate the functional significance of coronary fistula is not new. Intervention was considered for the coronary lesion and CAF in those cases with proven functional ischemia [3,6]. For this case, the operator decided to provisionally PCI the LAD lesion if the FFR reading was significant.…”

mentioning

confidence: 99%

Functional assessment of sequential coronary artery fistula and coronary artery stenosis with fractional flow reserve and stress adenosine myocardial perfusion imaging

Yew

Ooi

Law

2015

Journal of the Saudi Heart Association

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Coronary artery fistula is an abnormal connection between one coronary artery to another coronary artery or cardiac chambers. The coronary artery fistula may cause significant shunting of blood and cause "pseudo-stenosis" or "steal phenomenon". This will also accentuate pre-existing mild-moderate de novo coronary lesions with resultant greater pressure gradient difference across the lesions. Thus, fractional flow reserve can be a useful tool to guide intervention decision on the coronary artery fistula. There are very few published reports regarding the use of FFR to assess coronary artery fistula. In fact, there is no outcome data regarding the deferment of coronary artery fistula intervention when the FFR is not physiologically significant. This case highlighted the use of FFR to evaluate the functional significance of coronary fistula in the setting of ischemia evaluation and it was proven to be safe to defer intervention with good 3 year clinical outcome. Stress adenosine myocardial perfusion imaging correlated with the FFR result.

show abstract

Sequential moderate coronary artery fistula and moderate coronary artery stenosis causing ischemia demonstrated by fractional flow reserve and relieved following percutaneous coronary intervention

Cited by 8 publications

References 16 publications

Transcatheter Occlusion of Coronary-Pulmonary Fistula With a Liquid Embolic Agent After Evaluation by FFR

Transcatheter Occlusion of Coronary-Pulmonary Fistula With a Liquid Embolic Agent After Evaluation by FFR

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

Functional assessment of sequential coronary artery fistula and coronary artery stenosis with fractional flow reserve and stress adenosine myocardial perfusion imaging

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