Coronary Arteriovenous Fistula Research Articles

Surgical management of multiple coronary artery to coronary sinus fistulas with giant left circumflex artery and multivalvular infective endocarditis

Coronary artery fistula (CAF) is characterized as a congenital or acquired abnormal communication between a coronary artery and any of the four chambers of the heart (coronary–cameral fistula) or great vessels (coronary arteriovenous fistula) bypassing the capillaries within myocardium. CAF is a rare disease, challenging to diagnose and treat depending on the anatomical location and type of the fistula and accompanying diseases. This study aims to report a case with multiple coronary artery to coronary sinus (CS) fistulas with giant left circumflex artery and multivalvular infective endocarditis.

Acute myocardial infarction due to giant coronary artery aneurysm and arteriovenous fistula: a challenging case report and review of the literature

BackgroundA coronary artery aneurysm (CAA) is an abnormal dilation of a coronary artery segment often accompanied by coronary artery fistula (CAF), leading to communication between a coronary artery and a cardiac chamber or a part of the coronary venous system. Both CAAs and CAFs can present with symptoms and signs of myocardial ischemia and infarction.Case presentationWe describe the case of a 46-year-old woman with non-ST-elevation myocardial infarction (NSTEMI) caused by a “giant” CAA. Various imaging modalities revealed a thrombus-containing aneurysm located at the right-posterior cardiac border, with established arteriovenous communication with the distal part of left circumflex artery (LCx). After initial treatment with dual antiplatelet therapy, a relapse of pain was reported along with a new increase in troponin levels, electrocardiographic abnormalities, reduced left ventricular ejection fraction (LVEF) and thrombus enlargement. Surgical excision of the aneurysm was favored, revealing its true size of 6 cm in diameter. Τhe aneurysm was excised without complications. The patient remained asymptomatic during follow-up.ConclusionsManagement of rare entities such as “giant” CAAs and CAFs can be challenging. Cases such as this can serve as precedents to facilitate treatment plans and develop consistent recommendations, emphasizing the importance of personalized strategies for future patients.

Diagnosis and Management of Congenital Coronary Artery Fistulas in Adults.

This review describes the presentation, diagnosis, and management of congenital coronary artery fistulas (CAFs) in adults. CAFs are classified as coronary-cameral or coronary arteriovenous fistulas. Fistulous connections at the distal coronary bed are more likely to be aneurysmal with higher risk of thrombosis and myocardial infarction (MI). Medium-to-large or symptomatic CAFs can manifest as ischemia, heart failure, and arrhythmias. CAF closure is recommended when there are attributable symptoms or evidence of adverse coronary remodeling. Closure is usually achievable using transcatheter techniques, though large fistulas may require surgical ligation with bypass. Given their anatomic complexity, cardiac CT with multiplanar 3-D reconstruction can enhance procedural planning of CAF closure. Antiplatelet and anticoagulation are essential therapies in CAF management. CAFs are rare cardiac anomalies with variable presentations and complex anatomy. CAF management strategies include indefinite medical therapy, percutaneous or surgical CAF closure, and lifelong patient surveillance.

Transesophageal Echocardiographic Imaging of Left Circumflex Artery to Superior Vena Cava Communication: Characterizing the Coronary Arteriovenous Fistula

Transesophageal Echocardiographic Imaging of Left Circumflex Artery to Superior Vena Cava Communication: Characterizing the Coronary Arteriovenous Fistula

Total Endoscopic Surgical Treatment of a Gigantic Coronary Arteriovenous Fistula between Circumflex Artery and Superior Vena Cava through Right Anterior Mini-Thoracotomy

Total Endoscopic Surgical Treatment of a Gigantic Coronary Arteriovenous Fistula between Circumflex Artery and Superior Vena Cava through Right Anterior Mini-Thoracotomy

Transcoronary sinus repair of a severely dilated and tortuous right coronary artery fistulized to coronary sinus complicated with tricuspid valve insufficiency

BackgroundRight coronary artery (RCA) fistulized to the coronary sinus is rare condition in adult cardiac anomalies, and the management and operative indication are controversial.Case presentationWe describe the case of a 45-year female patient who presented with exertional dyspnea, accompanied by intermitted lower limbs and facial edema. She was diagnosed with severe tricuspid regurgitation second to a severely dilated RCA fistulized to the coronary sinus. After multidisciplinary discussion, she underwent surgery through routine medium sternotomy, the right atrium was opened under cardiopulmonary bypass. The coronary arteriovenous fistula from the distal portion of RC to a severely enlarged coronary sinus was found. Trans-coronary sinus closure of the fistula was performed with continuous stitching and a tricuspid ring annuloplasty was done. The patient recovered uneventful post operation.ConclusionAccording to current literatures, surgical treatment was adopted for this case, instead of endovascular intervention. The optimal approach for these cases should consider the heart’s anatomical characteristics. But we need to be aware of the occurrence of myocardial infarction and tricuspid regurgitation in the early and late stage after operation.

Surgical Correction of Coronary Arteriovenous Fistula in the Newborn Period

Surgical Correction of Coronary Arteriovenous Fistula in the Newborn Period

КОРОНАРНО-ПУЛЬМОНАЛЬНАЯ ФИСТУЛА

Coronary arteriovenous fistula (CAF) is a rare form of congenital heart disease. However, it is the most common type of congenital anomaly of the coronary arteries. [1] When there is the connection between the coronary artery and the chambers of the heart, it is called a coronary chamber fistula. The fistula may also be between a coronary artery and another adjacent vessel from the pulmonary or systemic circulation. An open fistula provides low-resistance flow by directing blood from an artery into a vein, heart chamber, or other low-pressure vessel such as the pulmonary artery. Patients with CAF may develop symptoms at birth or later in life, depending on the type of fistula and the presence of collateral circulation. Studies have reported an association between ventricular arrhythmias and sudden cardiac death syndromes in young adults and athletes with certain types of coronary anomalies, such as anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) [2-5]. The most common symptom is a myocardial ischemia. The purpose of this article is to present a clinical case of endovascular treatment of coronary pulmonary fistula. As a result of a modern diagnostic methods, such as CT angiography with three-dimensional reconstruction, it is not difficult to assess the degree and nature of the pathology. Having assessed the tactics, modern doctors are able to cope with coronary arteriovenous fistulas with great success using minimally invasive X-ray endovascular technologies.

Left ventricular inflow obstruction due to a coronary arteriovenous fistula: a paediatric case report

BackgroundWe report a rare case of left ventricular inflow obstruction from a branch of the left circumflex coronary artery to the right atrium caused by a coronary arteriovenous fistula (CAVF) in a young Japanese male child.Case presentationThe patient was diagnosed with CAVF following a heart murmur shortly after birth. The left-to-right shunt caused right ventricular volume overload and pulmonary congestion. An emergency surgical intervention was performed for the CAVF on day 6 after birth. However, by 5 years of age, his left ventricular inflow obstruction worsened. We found an abnormal blood vessel originating from the proximal part of a branch of the left circumflex coronary artery, circling the outside of the mitral valve annulus along the medial side of the coronary sinus. As the child gets older, the blood inflow into the left ventricle might get restricted further, resulting in left-sided heart failure.ConclusionOur findings suggest that even after CAVF closure surgery, it is essential to monitor for complications caused by progressive dilatation of a persistent CAVF.

Gigantic arteriovenous fistula between left coronary cusp and coronary sinus draining into the right atrium

ABSTRACT Coronary arteriovenous fistulas (CAF) are infrequent anatomic anomalies that establish a direct connection between coronary arteries and cardiac chambers. The reported incidence is extremely low and estimated at 0.002% in the general population. We report a rare case of CAF in a middle-aged man, who was asymptomatic but incidentally found to have a gigantic CAF on a low-dose Computed Tomography scan of his chest. The case was presented to cardiothoracic surgeons. Since the patient was asymptomatic, they recommended medical management and continued close surveillance. The Left Coronary Artery or its branches are extremely uncommon site for CAF. With the advances in technology, the network of veins including coronary sinus has gained further clinical relevance. While technology has helped elucidate many aspects of these rare anomalies, mysteries still remain. With continued research, we can expect more cost-effective and less invasive interventional therapies to be developed in the near future.

The first multicentre study on coronary anomalies in the Netherlands: MuSCAT

BackgroundCurrent guidelines on coronary anomalies are primarily based on expert consensus and a limited number of trials. A gold standard for diagnosis and a consensus on the treatment strategy in this patient group are lacking, especially for patients with an anomalous origin of a coronary artery from the opposite sinus of Valsalva (ACAOS) with an interarterial course.AimTo provide evidence-substantiated recommendations for diagnostic work-up, treatment and follow-up of patients with anomalous coronary arteries.MethodsA clinical care pathway for patients with ACAOS was established by six Dutch centres. Prospectively included patients undergo work-up according to protocol using computed tomography (CT) angiography, ischaemia detection, echocardiography and coronary angiography with intracoronary measurements to assess anatomical and physiological characteristics of the ACAOS. Surgical and functional follow-up results are evaluated by CT angiography, ischaemia detection and a quality-of-life questionnaire. Patient inclusion for the first multicentre study on coronary anomalies in the Netherlands started in 2020 and will continue for at least 3 years with a minimum of 2 years of follow-up. For patients with a right or left coronary artery originating from the pulmonary artery and coronary arteriovenous fistulas a registry is maintained.ResultsPrimary outcomes are: (cardiac) death, myocardial ischaemia attributable to the ACAOS, re-intervention after surgery and intervention after initially conservative treatment. The influence of work-up examinations on treatment choice is also evaluated.ConclusionsStructural evidence for the appropriate management of patients with coronary anomalies, especially (interarterial) ACAOS, is lacking. By means of a structured care pathway in a multicentre setting, we aim to provide an evidence-based strategy for the diagnostic evaluation and treatment of this patient group.Supplementary InformationThe online version of this article (10.1007/s12471-021-01556-9) contains supplementary material, which is available to authorized users.

A case report of coronary arteriovenous fistula with coronary aneurysm diagnosed by transthoracic echocardiography

A case report of coronary arteriovenous fistula with coronary aneurysm diagnosed by transthoracic echocardiography

Mid-Term Follow-Up of Asymptomatic Coronary Arteriovenous Fistulas in Children

Mid-Term Follow-Up of Asymptomatic Coronary Arteriovenous Fistulas in Children

Oclusão de volumosa fístula da artéria coronária direita para a cavidade ventricular direita utilizando Amplatzer® Vascular Plug II. Relato de caso e descrição técnica do procedimento

Coronary arteriovenous fistulas are rare anomalies that connect one or more coronary arteries to a cardiac chamber or other vascular structure. These communications can be occluded using percutaneous treatment, and there are currently several approaches and techniques. We report the case of an adolescent aged 12 years and 10 months, with a large fistula of the right coronary artery draining into the right ventricular cavity, in which the Amplatzer® Vascular Plug II device was used. The technical steps used are described in detail, with excellent immediate results.

A case report of a coronary artery fistula to coronary sinus with giant aneurysm: risk does not end with repair.

BackgroundIsolated coronary arteriovenous fistulas are extremely rare, accounting for 0.08–0.4% of all congenital heart disease. Closure of the fistula is recommended in cases of large dimensions, relevant left–right shunt, or ischaemic events. Thrombosis of the coronary aneurysms may occur as a postoperative complication.Case summaryWe report a case of a coronary fistula between the circumflex artery and coronary sinus with giant aneurysm. After a failed percutaneous closure attempt, the patient was surgically treated without major postoperative complications. Despite therapeutic anticoagulation and antiplatelet therapy, she presented at clinical follow-up with thrombosis of the dilated coronary artery without signs or symptoms of ischaemia.DiscussionManagement of coronary artery fistula may be challenging in cases in which initial percutaneous closure is unsuccessful. This particular case also highlights the importance of close follow-up, despite optimal therapy, to detect potentially lethal complications related to the low flow in the dilated coronary aneurysm.

Coexisting complex coronary fistula and systemic arteriovenous fistula in a middle-aged long-distance runner: demonstration with coronary CTA

Coexisting complex coronary fistula and systemic arteriovenous fistula in a middle-aged long-distance runner: demonstration with coronary CTA

Novel use of Konar-multifunctional occluder

Lifetech Konar-multifunctional occluder is a novel device which is primarily used for the closure of ventricular septal defects. Being "multifunctional", the occluder has the potential to be useful in various structural cardiac defects. We share our retrospective review from two centres regarding non-conventional usage of multifunctional occluders in CHD. Eight patients who underwent interventions using multifunctional occluders for lesions other than ventricular septal defects between March 2019 to September 2019 were included in the study. The patients were analysed based on demography, the size and type of lesion, procedural success, and development of complications. All patients were followed up in the outpatient department for a minimum period of 6 months. The median age and weight of the cohort were 3.2 years and 9 kg, respectively. Six patients had patent ductus arteriosus, while one patient had aorto-pulmonary window and one had a coronary arterio-venous fistula. The sizing of the occluders and the procedural approach were based on the underlying pathology. The most commonly used occluder was 6 × 4 mm variant. One patient had successful implantation but had significant intra-device residual flow and was thus replaced by a different occluder. There were no major complications, nor any incidences of device embolisation or malposition. On follow-up, all patients had uneventful course. Konar-multifunctional occluder can be safely used in lesions other than ventricular septal defects, when needed under specific circumstances. Its unique characteristics make it a versatile choice in a variety of cardiac lesions.

A MISMATCHED CONNECTION: A CASE OF CORONARY ARTERIOVENOUS FISTULA

Coronary Arteriovenous Fistula (AVF) is an exceedingly rare condition. The majority of coronary AVF are congenital malformations that occur in <0.002% of the population. A 44 year old Asian female presented with a new 2/6 systolic ejection murmur during a routine examination. The patient denied

Coronary anomalies in tetralogy of Fallot – A meta-analysis

BackgroundAn anomalous coronary artery is reported in 2% to 23% of patients with tetralogy of Fallot (TOF). Knowledge of coronary anatomy prior to corrective surgery is vital to avoid damage to vessels crossing the right ventricular outflow tract (RVOT). A meta-analysis on the prevalence of anomalous coronary arteries in TOF is lacking to date. Here, an overview of coronary anomalies in TOF is provided and implications for patient management are discussed. MethodsPubMed, Embase and Web of Science were searched. Analysis was done using Revman 5.3 (Cochrane Community, London). The primary analysis focused on the origin and proximal course of the right and left coronary arteries. In addition, the prevalence of large conus arteries and coronary arteriovenous fistulas (CAVF) was calculated. ResultsTwenty-eight studies, encompassing 6956 patients, were included; 6% of TOF patients have an anomalous coronary artery. Hereof, 72% cross the RVOT; the majority of the remaining 28% courses behind the aorta. Six percent of patients have a large conus artery and 4% a CAVF. Other coronary anomalies include a left or right coronary artery from the pulmonary trunk or left or right pulmonary artery, coronary tree hypoplasia and anastomoses between coronary and bronchial arteries. ConclusionsThe prevalence of coronary anomalies in TOF is 4–6%. In patients with an anomalous coronary artery, 72% cross the RVOT. The combined risk of encountering an anomalous coronary artery or a large conus artery crossing the RVOT is 10.3%. Coronary anatomy should be defined before surgery and the surgical approach adapted accordingly.

Transcatheter coil embolization of multiple symptomatic coronary arteriovenous fistulas: lessons from long‑term follow‑up.

Transcatheter coil embolization of multiple symptomatic coronary arteriovenous fistulas: lessons from long‑term follow‑up.