Abstract
BackgroundCoronary bronchial artery fistulas (CBFs) are rare anomalies, which may be isolated or associated with other disorders.Materials and methodsTwo adult patients with CBFs are described and a PubMed search was performed using the keywords “coronary bronchial artery fistulas” in the period from 2008 to 2013.ResultsTwenty-seven reviewed subjects resulting in a total of 31 fistulas were collected. Asymptomatic presentation was reported in 5 subjects (19 %), chest pain (n = 17) was frequently present followed by haemoptysis (n = 7) and dyspnoea (n = 5). Concomitant disorders were bronchiectasis (44 %), diabetes (33 %) and hypertension (28 %). Multimodality and single-modality diagnostic strategies were applied in 56 % and 44 %, respectively. The origin of the CBFs was the left circumflex artery in 61 %, the right coronary artery in 36 % and the left anterior descending artery in 3 %. Management was conservative (22 %), surgical ligation (11 %), percutaneous transcatheter embolisation (30 %), awaiting lung transplantation (7 %) or not reported (30 %).ConclusionsCBFs may remain clinically silent, or present with chest pain or haemoptysis. CBFs are commonly associated with bronchiectasis and usually require a multimodality approach to be diagnosed. Several treatment strategies are available. This report presents two adult cases with CBFs and a review of the literature.
Highlights
Coronary bronchial artery fistulas (CBFs) are usually found incidentally during invasive coronary angiography (CAG) [1]
We report two adult patients with angina pectoris in whom CAG demonstrated significant obstructive coronary artery disease (CAD), and coincidentally CBFs were found
The first patient was treated with stenting of the circumflex artery (Cx) coronary artery, and in a second session the fistulous vessel was occluded by coiling during a percutaneous transcatheter embolisation (PTE) procedure
Summary
Coronary bronchial artery fistulas (CBFs) are usually found incidentally during invasive coronary angiography (CAG) [1]. MDCT identified the course of CBFs between the circumflex artery (Cx) and the bronchial arteries [2, 5] and myocardial perfusion imaging (MPI) revealed reversible defects [5]. We report two adult patients with angina pectoris in whom CAG demonstrated significant obstructive coronary artery disease (CAD), and coincidentally CBFs were found. The first patient was treated with stenting of the Cx coronary artery, and in a second session the fistulous vessel was occluded by coiling during a percutaneous transcatheter embolisation (PTE) procedure. The second patient had associated bronchiectasis, sustained a subclinical anterior wall myocardial infarction (MI), and was treated medically for his CBF.
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