Cardiac tamponade as a rare complication after giant coronary fistula percutaneous closure

Pablo Díez Villanueva,Ricardo Sanz-Ruíz,Jaime Elízaga-Corrales,Fernando Sarnago Cebada,Enrique Gutiérrez Ibañes,Francisco Fernández-Avilés

doi:10.4236/wjcd.2013.32031

Abstract

We present the case of an unusual complication after percutaneous closure of a giant coronary artery fis-tula. A 76-year-old man with previous admissions due to right heart failure and previous history of atrial fibrillation under acenocumarol, was admitted to our hospital for new onset of symptoms, characterized by progressive dyspnoea and peripheral edema. Physical examination revealed signs of congestive heart failure and a continuous murmur loudest along the lower sternal border. X-Ray showed cardiomegaly due to right chambers dilatation. Transthoracic echocardiography showed right chambers pressure and volume overload, with right ventricular enlargement and dysfunction, tricuspid annulus dilatation and severe tricuspid regurgitation. Cardiac catheterization showed significant elevation of right atrial pressure, as well as significant step-up of oxygen saturation in this chamber. Coronary angiography revealed the presence of a large fistula between the circumflex coronary artery (CCA) and coronary sinus (CS), with severe dilation of the CCA (maximum diameter20 mm). An Amplatzer? PDA was implanted in a distal elbow of the fistula with initailly good results. Anticoagulant therapy was then reinitiated, and a few days later, the patient developed clinical worsening of heart failure and dyspnoea. Echocardiogram showed significant pericardial effusion. Pleuropericardial window was then made draining a500 cm3 of bloody pericardial effusion. The postoperative outcome was excellent, with symptomatic relief and no signs of heart failure.

Highlights

Coronary artery fistulas (CFA) are rare, usually congenital entities, resulting in abnormal communications between a coronary artery and, usually, any low-pressure structure, entailing a left-to-right shunt bypassing the capillary bed
We present the case of an unusual complication after percutaneous closure of a giant coronary artery fistula
Coronary angiography revealed the presence of a large fistula between the circumflex coronary artery (CCA) and coronary sinus (CS), with severe dilation of the CCA

Summary

INTRODUCTION

Coronary artery fistulas (CFA) are rare, usually congenital entities, resulting in abnormal communications between a coronary artery and, usually, any low-pressure structure, entailing a left-to-right shunt bypassing the capillary bed. Such fistulas most often arise from the right coronary artery, while the circumflex coronary artery is rarely involved. There is a wide range of symptoms; most patients may be asymptomatic, while others may present with dyspnea, congestive heart failure or angina. Management of asymptomatic patients with small coronary artery fistula remains controversial, as the natural history of coronary artery fistulas is variable. Surgical or percutaneous closure is indicated in case of symptomatic or significant shunt. Bloody pericardial effusion as main complication after a percutaneous intervention had never been described as a post-percutaneous procedure complication

CASE DESCRIPTION

Findings

DISCUSSION