Coronary Arteriovenous Fistula Research Articles

Coronary arteriovenous fistula originating from the left coronary artery and draining into the superior vena cava.

Coronary arteriovenous fistulas are rare coronary anomalies. Most fistulas arise from the right coronary artery and drain into the right heart structures. We report a case of a 59-year-old man with a rare coronary arteriovenous fistula that originates from the left coronary artery and drains into the superior vena cava. He was diagnosed incidentally with cardiac computed tomography during the investigation for atrial fibrillation. Surgical fistula ligation was successfully performed under cardiac arrest with cardiopulmonary bypass. The patient was discharged without complications.

Bipolar radiofrequency ablation of refractory ventricular arrhythmias: results from a multicentre network.

Advanced ablation strategies are needed to treat ventricular tachycardia (VT) and premature ventricular complexes (PVC) refractory to standard unipolar radiofrequency ablation (Uni-RFA). Bipolar radiofrequency catheter ablation (Bi-RFA) has emerged as a treatment option for refractory VT and PVC. Multicentre registry data on the use of Bi-RFA in the setting of refractory VT and PVC are lacking. The aim of this Bi-RFA registry is to determine its real-world safety, feasibility, and efficacy in patients with refractory VT/PVC. Consecutive patients undergoing Bi-RFA at 16 European centres for recurring VT/PVC after at least one standard Uni-RFA were included. Second ablation catheter was used instead of a dispersive patch and was positioned at the opposite site of the ablation target. Between March 2021 and August 2024, 91 patients underwent 94 Bi-RFA procedures (74 males, age 62 ± 13, and prior Uni-RFA range 1-8). Indications were recurrence of PVC (n = 56), VT (n = 20), electrical storm (n = 13), or PVC-triggered ventricular fibrillation (n = 2). Procedural time was 160 ± 73 min, Bi-RFA time 426 ± 286 s, and mean Uni-RFA time 819 ± 697 s. Elimination of clinical VT/PVC was achieved in 67 (74%) patients and suppression of VT/PVC in a further 10 (11%) patients. In the remaining 14 patients (15%), no effect on VT/PVC was observed. Three major complications occurred: coronary artery occlusion, atrioventricular block, and arteriovenous fistula. Follow-up lasted 7 ± 8 months. Nineteen patients (61%) remained VT free. ≥80% PVC burden reduction was achieved in 45 (78%). These real-world registry data indicate that Bi-RFA appears safe, is feasible, and is effective in the majority of patients with VT/PVC.

Coronary arteriovenous fistula: role of cardiovascular computed tomography

Coronary arteriovenous fistula: role of cardiovascular computed tomography

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.

Peculiar association of a small coronary arteriovenous fistula with inferior wall myocardial infarction

Coronary arteriovenous fistula (CVAF) is usually an asymptomatic, incidental finding observed in 0.1%–0.2% of patients undergoing coronary angiography. Myocardial infarction (MI) secondary to a CVAF has been rarely reported. We herein describe a case of a young male presenting with acute inferior wall MI without any underlying cardiovascular risk factors and normal coronaries except for the presence of a small CVAF arising from the proximal right coronary artery. This report deliberates on the possibility of this fistula being an incidental finding as a bystander or as a culprit in this special clinical scenario, after careful exclusion of other possible nonatherosclerotic etiologies.

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