Successful surgical repair of a giant left main coronary artery aneurysm with arteriovenous fistula draining into a persistent left superior vena cava and coronary sinus: role of intraoperative transesophageal echocardiography

Makaryus, Amgad N.; Kort, Smadar; Rosman, David; Vatsia, Sheel K.; Mangion, Judy R.

doi:10.1067/j.echo.2003.08.007

Cited by 14 publications

(14 citation statements)

References 16 publications

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“…Doppler echocardiography remains of great diagnostic value in the detection, intra-operative imaging and follow-up of patients with CAFs [2,22] . CAFs could be suspected [7,8] and confirmed [51,65,66] by echocardiography, as well as demonstration of dilatation and aneurysm of the donor vessel [34,36,[67][68][69][70] and dilatation of the recipient chamber [3,4,[71][72][73] . Thrombotic or vascular masses have been visualized by echocardiography [72] .…”

Section: Abnormal Shadow On Chest X-raymentioning

confidence: 99%

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Current characteristics of congenital coronary artery fistulas in adults: A decade of global experience

Saïd

2011

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AIM:To describe the characteristics of coronary artery fistulas (CAFs) in adults, including donor vessels and whether termination was cameral or vascular. METHODS:A PubMed search was performed for articles between 2000 and 2010 to describe the current characteristics of congenital CAFs in adults. A group of 304 adults was collected. Clinical data, presentations, diagnostic modalities, angiographic fistula findings and treatment strategies were gathered and analyzed. With regard to CAF origin, the subjects were tabulated into unilateral, bilateral or multilateral fistulas and compared. The group was stratified into two major subsets according to the mode of termination; coronary-cameral fistulas (CCFs) and coronary-vascular fistulas (CVFs). A comparison was made between the two subsets. Fistula-related major complications [aneurysm formation, infective endocarditis (IE), myocardial infarction (MI), rupture, pericardial effusion (PE) and tamponade] were described. Coronary artery-ventricular multiple micro-fistulas and acquired CAFs were excluded as well as anomalous origin of the coronary arteries from the pulmonary artery (PA). RESULTS:A total of 304 adult subjects (47% male) with congenital CAFs were included. The mean age was 51.4 years (range, 18-86 years), with 20% older than 65 years of age. Dyspnea (31%), chest pain (23%) and angina pectoris (21%) were the prevalent clinical presentations. Continuous cardiac murmur was heard in 82% of the subjects. Of the applied diagnostic modalities, chest X-ray showed an abnormal shadow in 4% of the subjects. The cornerstone in establishing the diagnosis was echocardiography (68%), and conventional contrast coronary angiography (97%). However, multislice detector computed tomography was performed in 16%. The unilateral fistula originated from the left in 69% and from the right coronary artery in 31% of the subjects. Most patients (80%) had unilateral fistulas, 18% presented with bilateral fistulas and 2% with multilateral fistulas. Termination into the PA was reported in unilateral (44%), bilateral (73%) and multilateral (75%) fistulas. Fistulas with multiple origins (bilateral and multilateral) terminated more frequently into the PA (29%) than into other sites (10.6%) (P = 0.000). Aneurysmal formation was found in 14% of all subjects. Spontaneous rupture, PE and tamponade were reported in 2% of all subjects. In CCFs, the mean age was 46.2 years whereas in CVFs mean age was 55.6 years (P = 0.003). IE (4%) was exclusively associated with CCFs, while MI (2%) was only found in subjects with CVFs. Surgical ligation was frequently chosen for unilateral (57%), bilateral (51%) and multilateral fistulas (66%), but percutaneous therapeutic embolization (PTE) was increasingly reported (23%, 17% and 17%, respectively). CONCLUSION:Congenital CAFs are currently detected in elderly patients. Bilateral fistulas are more frequently reported and PTE is more frequently applied as a therapeutic strategy in adults.

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Section: Abnormal Shadow On Chest X-raymentioning

confidence: 99%

“…Only a few ended in the left heart side [75] . Mild [14,75] , moderate [71] to severe [11] pulmonary hypertension was recorded. Dilatation [10,12,14] of the LMT was not frequently observed.…”

Section: Abnormal Shadow On Chest X-raymentioning

confidence: 99%

Current characteristics of congenital coronary artery fistulas in adults: A decade of global experience

Saïd

2011

WJC

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“…Mild to moderate pulmonary hypertension was described in 3 reports [12,28,44]. Myocardial infarction (MI) was documented in 3 octogenarian subjects; 2 males and 1 female (all had an Asian ethnic origin).…”

Section: Gender and Fistula Characteristicsmentioning

confidence: 99%

“…Gradual dilatation of the fistulous vessels, spanning over many years, may be observed with increasing age and this may explain the late onset of symptoms and the delayed development of congestive heart failure and atrial fibrillation in the elderly subjects [24][25][26][27][28].…”

Section: Introductionmentioning

confidence: 99%

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Gender-related differences in octogenarians with congenital coronary artery fistula: a report of two cases and a review

2011

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Aim To highlight gender-related differences in octogenarians with a congenital coronary artery fistula (CAF). Materials and methods We present two elderly female patients with a congenital fistula, a septuagenarian and a nonagenarian, and review the world literature between 1954-2010. Results The septuagenarian patient presented with easy fatigability and the nonagenarian patient with acute myocardial infarction contralaterally to the fistula. Coronary angiography (CAG) demonstrated a coronary-pulmonary artery fistula (CPF). The nonagenarian patient underwent percutaneous coronary intervention of the right coronary artery. CAG revealed a CPF associated with a huge multiple aneurysmal formation. Data from 57 mainly symptomatic patients with a mean age of 75.3 years (range 70-87 years) were collected. The cohort was subdivided into female (mean age 84.3 years) and male (mean age 75.2 years) subgroups and compared with each other. Multi-origin (bilateral and multilateral) was prevalent in females, 40% versus 12% in males. Aneurysmal formation was found in females and males in 40% and 18%, respectively. Ethnicity was 65% Caucasian and 35% Asian. Multi-origin fistulas were prevalent in the Asian (45%) compared with the Caucasian (11%) subset. Conclusions A septuagenarian and a nonagenarian female patient with congenital CAF are presented. On reviewing the literature, important differences were found between elderly females and males with congenital CAF.

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Giant coronary artery aneurysm with coronary arteriovenous fistula draining into the coronary sinus

et al. 2011

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A 77-year-old patient suffering from a giant right coronary artery aneurysm with coronary arteriovenous fistula was admitted to our hospital. The fistula could not be documented preoperatively by computed tomography or coronary angiography but was documented intraoperatively by transesophageal echocardiography (TEE). However, TEE was unable to visualize the draining site of the fistula. Direct palpation by the surgeon ultimately confirmed that the fistula was draining into the coronary sinus. The fistula was closed and the volume of the aneurysm reduced by partial resection. The postoperative course of the patient was uneventful. Giant aneurysms occasionally displace cardiac structures. In such cases, combined imaging technologies, including TEE, may be needed for precise assessment of the giant aneurysm and fistula.

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Successful surgical repair of a giant left main coronary artery aneurysm with arteriovenous fistula draining into a persistent left superior vena cava and coronary sinus: role of intraoperative transesophageal echocardiography

Cited by 14 publications

References 16 publications

Current characteristics of congenital coronary artery fistulas in adults: A decade of global experience

Current characteristics of congenital coronary artery fistulas in adults: A decade of global experience

Gender-related differences in octogenarians with congenital coronary artery fistula: a report of two cases and a review

Giant coronary artery aneurysm with coronary arteriovenous fistula draining into the coronary sinus

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