Surgical repair of complicated coronary arteriovenous fistula and coronary artery aneurysm in an elderly patient after 26 years of conservative therapy

Abstract

We describe a rare case of surgical repair of a coronary artery aneurysm with arteriosclerotic changes accompanied by coronary arteriovenous fistula (CAVF) after 26 years of conservative therapy. A 71-year-old woman, diagnosed with CAVF 26 years previously, was admitted to our hospital for general fatigue and dyspnea on exertion. Physical examinations revealed that the CAVF originated from the distal portion of the left circumflex artery (LCX), draining into the coronary sinus (CS); it affected the coronary artery aneurysm with arteriosclerotic changes and was calcified from the left coronary main trunk to the distal portion of the LCX. Treatment without resection of the calcified coronary aneurysm was suggested because of fear of excessive bleeding. The CAVF was closed directly from inside the dilated coronary sinus under cardiopulmonary bypass. The dilated ostium of the left coronary artery was closed using a Xenomedica patch. Coronary artery bypass grafting was performed in the left anterior descending artery (LAD) and posterolateral branch (PL) of the LCX using saphenous vein grafts. Postoperatively, the coronary aneurysm was spontaneously thrombosed for low blood flow. The bleeding might have been uncontrolled if the arteriosclerotic and calcified coronary aneurysm had been incised. Therefore, we successfully thrombosed the calcified coronary aneurysm without resection, after reducing the systemic blood flow to the coronary aneurysm and sustaining the coronary blood flow, performed with CABG.

Coronary Artery Fistulas: Case Series and Literature Review

“…CAFs are defined as abnormalities of termination. There is abnormal direct communication between one or more coronary arteries with another vessel (also called coronary-vascular fistulas) or a cardiac chamber (called coronary-cameral fistulas) bypassing the myocardial capillary network [2,3,4,5,6,7,8]. This is in contrast to abnormalities of origin (i.e., anomalous coronary arteries or arteries arising from the pulmonary artery).…”

Percutaneous closure of congenital coronary artery fistulae in 5 children: A single center experience

“…In the remaining patients, they are to be managed conservatively or with surgery. 23 Percutaneous CAF closure is reported to yield a high degree of procedural success with low risk of serious complications. 7 During percutaneous closure of CAF, multiple devices have been used including coils, detachable balloons, covered stents, vascular plugs, atrial septal defect occluder, VSD occluder and PDA occluder.…”

Successful percutaneous coil embolization of coronary–pulmonary, –carotid, and –internal mammary artery fistulas

“…Percutaneous intervention for coronary artery fistulas is a good choice, especially for a fistula with a single origin and drainage site and without extreme tortuosity [20,21]. If a patient has multiple coronary artery fistulas or additional heart disease requiring surgery (e.g., ventricular septal defect, coronary artery aneurysm, or atherosclerotic coronary artery disease requiring a coronary artery bypass graft), surgical treatment is preferred [20][21][22][23].…”