Abstract
Coronary artery fistulas (CAF) are rare but hemodynamically significant anomalies. Although asymptomatic, they can be associated with several cardiorespiratory conditions. Coronary to bronchial fistulas (CBF) account for 0.5% to 0.61% of coronary artery fistulas, with fistulas arising from the right coronary artery being exceedingly rare. These fistulas are known to be associated with bronchiectasis but not lung bullae. The following paper reports a rare case of a coronary to bronchial fistula associated to bronchiectasis and lung bullae. The patient presented for dyspnea and was found to have a large lung bullae, bronchiectasis and a coronary to bronchial artery fistula arising from the right coronary artery and terminating into the left bronchial artery. The CBF was successfully managed first with percutaneous microcoil embolization then the bullae was resected thoracoscopically three days later. However, more case reports are mandatory in order to further understand the etiology and pathophysiology of these fistulas, elucidate their relationship to other pathologies such as bronchiectasis and lung bullae and determine the optimal therapeutic measures.
Highlights
IntroductionThey are rare anomalies of congenital or acquired origins [1], often incidentally discovered on invasive angiography given their asymptomatic nature, especially during the first 2 decades of life [2,3]; these fistulas are the most common coronary artery anomalies that can alter coronary hemodynamic parameters [4], and are associated with angina, myocardial infarctions, heart failure, arrhythmias, and infective endocarditis [1,2,3]
Coronary artery fistulas (CAF) Accounts for 0.3% of congenital heart diseases. They are rare anomalies of congenital or acquired origins [1], often incidentally discovered on invasive angiography given their asymptomatic nature, especially during the first 2 decades of life [2,3]; these fistulas are the most common coronary artery anomalies that can alter coronary hemodynamic parameters [4], and are associated with angina, myocardial infarctions, heart failure, arrhythmias, and infective endocarditis [1,2,3]. Their prevalence ranges between 0.002% to 0.4% on coronary angiography [1], computed tomographic angiography (CTA) reveals a prevalence close to 0.9% [5]
Coronary-bronchial fistulas make of the rarest classification of coronary artery fistulas with a prevalence of 0.5% at coronary angiography and 0.61% on CTA [1]. 90% of CAFs are of congenital origins secondary to failure of regression of myocardial sinusoids, as with coronary-cameral fistulas, or the persistence of primitive communications between coronary & mediastinal vessels [1]
Summary
They are rare anomalies of congenital or acquired origins [1], often incidentally discovered on invasive angiography given their asymptomatic nature, especially during the first 2 decades of life [2,3]; these fistulas are the most common coronary artery anomalies that can alter coronary hemodynamic parameters [4], and are associated with angina, myocardial infarctions, heart failure, arrhythmias, and infective endocarditis [1,2,3] Their prevalence ranges between 0.002% to 0.4% on coronary angiography [1], computed tomographic angiography (CTA) reveals a prevalence close to 0.9% [5]. The fistula was successfully managed with percutaneous microcoil embolization while the bulla was resected few days later
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