Coronary Artery Fistula Research Articles

A Case of Right Coronary Artery Fistula to Right Ventricle with Associated Aneurysm and Thrombus in Pregnant Lady

A Case of Right Coronary Artery Fistula to Right Ventricle with Associated Aneurysm and Thrombus in Pregnant Lady

Surgical Correction of Coronary Artery Ectasia Combining Congenital Coronary Artery Fistula

Surgical Correction of Coronary Artery Ectasia Combining Congenital Coronary Artery Fistula

Progression of artery aneurysm after transcatheter closure of coronary artery fistula.

Progression of artery aneurysm after transcatheter closure of coronary artery fistula.

Coronary artery fistulas morphology in coronary computed tomography angiography.

The aim of the study was to evaluate coronary artery fistulas (CAFs) in coronary computed tomography angiography (coronary CTA) and verify whether there is correlation between the fistula's morphology and other cardiac functional findings and clinical data. A group of 14,308 patients who were diagnosed in coronary CTA was retrospectively analysed. Achieved data were related to referrals. Coronary artery fistula frequency was 0.43% in the examined population. The assessment of coronary artery disease was the most frequent indication for the examination. In 2 out of 3 cases the diagnosis of CAFs was incidental. Fistulas to cardiac chambers were significantly shorter than those to other vascular structures (19.9 vs. 61.8 mm, respectively, p = 0.001). Pulmonary trunk was most often the drainage site. Fistulas with singular supply and drainage constituted the majority. The new morphologic classification of CAFs was introduced with linear, spiral, aneurysmal, grid-like and mixed types. Most numerous was the spiral type group. Patients with aneurysmal fistulas had a tendency for wider diameter of aorta and pulmonary trunk. Smallest left ventricle fraction was observed in gridlike fistulas (48.0%, comparing to 59.2% for all patients with fistulas, p = 0.001). Concomitant abnormalities were found in 13.1% of CAFs patients. Computed tomography angiography has proven to be a useful tool in CAFs detection and morphological assessment. Proposed classification may simplify the predictions whether fistula has a significant influence on cardiac function; however, further studies are needed.

Simple Provisional Stenting or two-stent Strategies to Treat Anomalous Right Coronary Originating from the mid of left Anterior Descending Coronary Artery

Congenital anomalies of coronary arteries (CAAS) are very rare and usually documented as an incidental finding during routine catheter or CT angiograms performed for other reasons. Their prevalence ranges from 0.2% to 1.3% based published series. The most common coronary artery anomaly is origination of the left circumflex coronary (LCX) artery from the proximal of right coronary artery (RCA) or right sinus of Valsalva. The second is separate origination of the left anterior descending coronary artery (LAD) and LCX artery from the left sinus of Valsalva. Herein, we present three cases that the anomalous RCA arises from the mid of left anterior descending coronary artery (LAD). The bifurcation lesions of first case was treated using two-stent strategies of DK culotte, excellent angiography results was observed. The last two cases were treated using simple provisional stenting strategy: one stent was deployed crossover the ostium of the anomalous coronary artery, final angiographic results were excellent. These cases are extremely rare. We bring forth them in an attempt to highlight their significance, and make cardiologist to understand what important the anomalies are, and the strategy how to treatment these bifurcation lesions.

COILUMICA: coil embolization of a coronary artery to pulmonary artery fistula via novel dual lumen micro catheter technique

BackgroundManagement of coronary artery fistula (CAF) is based on obliterating the fistula communication between the cardiac arteries and other thoracic vessels.Case presentationWe describe the presentation of an 85-year-old female with progressive exertional dyspnea on a background of a long standing left anterior descending diagonal to pulmonary artery fistula. We utilized neuro-interventional techniques to perform coil embolization via use of a Scepter XC dual lumen micro catheter.ConclusionsDual lumen balloon catheters allow for super-selective artery interrogation, stability of balloon positioning, with less trauma to vessel architecture and accurate embolization. There were no complications and the patient reported improvement of symptoms on review.

Utilization and outcomes of transcatheter coil embolization for various coronary artery lesions: Single-center 12-year experience.

Determining the outcomes of transcatheter coil embolization (TCE) for several coronary artery lesions. TCE has been used as a treatment modality for various lesions in the coronary circulation. However, data on the efficacy and safety of TCE to treat coronary artery fistula (CAF), left internal mammary artery (LIMA) side-branch, coronary artery perforation (CAP), coronary artery aneurysm (CAA), and coronary artery pseudoaneurysm (CAPA) are limited. We conducted a retrospective, descriptive analysis of all TCE devices in coronary lesions at our center from 2007 to 2019. Forty-one studied lesions included 25 CAF, 7 LIMA side-branch, 5 CAP, 2 CAA, and 2 CAPA. Short- and 1-year mortality and hospital readmission were reported, in addition to coil-related complications and procedural success. The utilization rate of TCE in coronary artery lesions at our center was found to be 33.8 per 100,000 percutaneous coronary intervention procedures over 12 years. Successful angiographic closure was achieved in 37 out of 41 (87.8%) cases (88, 100, 60, 100, and 100% of CAF, LIMA side-branch, CAP, CAA, and CAPA, respectively). No adverse events were directly related to TCE among the LIMA, CAA, and CAPA cases, and only one patient with CAF required reintervention at 3 months due to coil migration. Coil embolization in our institution was safe and effective in treating different coronary circulation abnormalities with a 87.8% overall success rate. Further study on the use of vascular plug devices in cases such as CAF or LIMA side-branch would be beneficial to understand the treatment options better.

Abstract 12850: Isolated and Assisted Transcatheter Coil Embolization of Coronary Artery Lesions: The Cleveland Clinic Experience

Introduction: Transcatheter coil embolization (TCE) has been introduced as a modality in treating several coronary artery lesions including coronary artery fistula (CAF), patent left internal mammary artery (LIMA) side branch, coronary artery perforation (CAP), coronary artery aneurysm (CAA), and coronary artery pseudoaneurysm (CAPA) is limited. Hypothesis: TCE is underutilized in various coronary lesions despite its efficacy. Methods: This is a retrospective, descriptive study of all adult patients who underwent TCE at the Cleveland Clinic between August 2007 and August 2019. A total of 41 patients, including 25 CAF, 7 patent LIMA side branches, 5 CAP, 2 CAA, and 2 CAPA from a total of 121,196 cases, were studied. Results: Successful angiographic closure was performed in 37 out of 41 (90%) cases (100% ,100% ,100%, 88%, 80%, of patent LIMA side branch ,CAA, CAPA, CAF, CAP, respectively). Ampatzer vascular plug was used as an adjunctive device in 10% of the total cohort. No adverse events were directly associated with TCE among the LIMA, CAA, and CAPA lesions, and only one patient with CAF required re-intervention at three months due to coil migration. One patient with a large CAP of the mid-left anterior descending artery died while hospitalized due to cardiogenic shock despite successful embolization. Conclusions: Transcatheter Coil embolization in our institution was safe and effective in treating different coronary circulation abnormalities with successful angiographic results in 90% of treated cases. Additional study on the utilization of vascular plug devices in cases such as LIMA side branch or CAF would be beneficial to better understand the treatment options.

Abstract 14694: Coronary Artery Fistula Presenting With Complete Heart Block and Syncope

Introduction: Coronary artery fistula (CAF) is an anomalous connection between one or more coronary arteries and a cardiac chamber or great vessel. The incidence of coronary fistulas is estimated to be 0.2-0.4% of all cardiac malformations. We present a 75 year old female who presented with a complete heart block, which was most likely caused by a fistula between the coronary vasculature and the pulmonary trunk. Clinical presentation: A 75 year old female with a past medical history of hypertension, hyperlipidemia, and COPD presented with two episodes of syncope. Clinical examination was unremarkable. The EKG showed complete third degree heart block requiring transcutaneous pacing. Echocardiography showed normal left ventricular size and function, with an ejection fraction of 55%. The right ventricle size and function were also normal. No hemodynamically significant valvular disease was seen. Left heart catheterization showed occluded middle right coronary artery, 50% stenotic lesion in the left anterior descending artery (LAD), and an abnormal termination of the first diagonal branch of the LAD (D1) into the pulmonary trunk indicative of a fistula. The fistula was the presumed cause of the complete heart block in this patient. The fistula was managed by observation rather than surgical intervention while a dual chamber pacemaker was placed to address the complete heart block. Conclusions: Coronary artery fistulas are either congenital or acquired. They are rare and usually asymptomatic but can present with a myriad of symptoms. Our case describes a patient presenting with complete heart block and syncope, with a fistula detected on coronary angiography. This is considered the gold standard for diagnosing CAF. Disrupted coronary flow leading to ischemic complete heart block is the presumed process leading to syncope in this patient. Other modalities that can assist in this diagnosis include echocardiography, computed tomography, or magnetic resonance imaging.

Congenital coronary artery fistula in pediatric patients: transcatheter versus surgical\xa0closure

ObjectivesTranscatheter closure (TCC) and surgical closure (SC) are the two main approaches for congenital coronary artery fistula (CCAF), but data on the comparisons of the efficacy and safety of these two approaches are limited.MethodsWe retrospectively reviewed pediatric patients with CCAF in Guangdong Cardiovascular Institute between January 2002 and December 2017. Patients who were qualified into our criteria were included into final analysis. The rate of successful closure and complications during hospitalization and at follow-up were compared between SC and TCC groups.ResultsIn total, 121 pediatric patients (male, n = 69; female, n = 52) with CCAF were divided to TCC (n = 63) and SC groups (n = 58) according to the indications. The mean age was 5.3 ± 1.4 years. The baseline characteristics of these two groups were similar except for the fistula anatomic feature. After adjusted for the fistula anatomy, compared to SC, TCC was associated with higher risk of major complications (p = 0.013). Proportions of patients requiring blood transfusion and intra-operative blood loss were higher in SC versus TCC groups, as were longer duration of hospital and ICU stay during hospitalization. In contrast, myocardial ischemia (10.2% vs 0.0%, p = 0.028), residual shunts (16.9% vs 3.6%, p = 0.045) and new-onset moderate-to-severe valve regurgitation (11.9% vs 0.0%, p = 0.013) were higher in TCC group versus SC groups during follow-up.ConclusionsTCC has less invasive and faster recovery. However, SC had a higher successful rate and lower risk of major complications in pediatric patients.

Left Coronary Artery to Right Ventricle Fistula—Flow Patterns Evaluated by Doppler Echocardiography: a Case Report

Coronary artery fistulas (CAFs) are rare congenital heart diseases in which there is a communication between a coronary artery and a cardiac chamber or a great vessel. Its diagnosis can be made noninvasively by echocardiography. We report a case of left anterior descending coronary artery (LAD) to right ventricle fistula where the diagnosis was made by 2D and Doppler echocardiography. The fistula was an incidental finding in an asymptomatic 5-year-old child who underwent echocardiography because of a loud cardiac murmur on physical examination. The Doppler study allowed to accurately evaluate the haemodynamic consequences of the fistula. With this case report, we want to highlight how the typical flow pattern of a left coronary artery to RV fistula can be studied by a comprehensive Doppler echocardiography examination. The knowledge of the Doppler appearance in these cases can help to appreciate the pathophysiology of the fistula and to differentiate between other concomitant abnormalities such as muscular ventricular septal defects (VSDs).

Transcatheter Closure of Large Coronary-Cameral Fistulas Using the Patent Ductus Arteriosus Occluder or Amplatzer Vascular Plugs.

Transcatheter closure (TCC) has emerged as the first-line treatment for coronary artery fistulas. However, limited data exist regarding the long-term outcomes and technical aspects of this procedure. We aimed to report the long-term outcomes and technical aspects of TCC of large coronary-cameral fistulas (CCFs).All patients with large CCFs who underwent attempted TCC using the patent ductus arteriosus (PDA) occluder or Amplatzer vascular plug (AVP), from June 2002 to December 2017, were retrospectively reviewed. A total of 23 patients with large CCFs underwent attempted TCC using the PDA occluder or AVP. Most CCFs originated from the right coronary artery and drained predominantly into the right heart chamber. Procedural success was achieved in 21 (91.3%) patients. Devices were deployed using the arteriovenous loop in 15, transarterial approach in 4, and arterio-artery loop approach in 2 patients. Procedural complications included coronary spasm in one and side branch occlusion in one patient. Among these 21 patients with successful device implantation, follow-up angiograms or computed tomography angiograms were obtained in 14 (66.7%) patients at a median of 11.0 (range, 9.8-16.3) months. Late complications included thrombosis of residual fistula segment without myocardial infarction (MI) in one, coronary thrombosis resulting in MI in one, and recanalization necessitating re-intervention in one patient. No death and device embolization occurred.TCC of large CCFs using the PDA occluder or AVP is an effective therapy in anatomically suitable candidates, with favorable long-term outcomes. Given that potentially hazardous complications may occur late after the procedure, long-term periodic evaluation is mandatory.

Coronary artery fistulas: a single-center case series

Abstract Introduction Coronary artery fistulas (CAFs) are rare anomalous connections between a coronary artery and a major vessel or cardiac chamber. Currently they are being increasingly encountered due to the more widespread use of various imaging modalities and coronary angiography. Although the vast majority of CAFs are incidentally diagnosed and have no clinical relevance, they can cause significant morbidity such as myocardial infarction, congestive heart failure and endocarditis. Methods A consecutive series of 55867 coronary arteriograms performed in our Cardiology Department from 2007 to 2019 was retrospectively investigated for the presence of coronary artery fistulas. Patients clinical, angiographic and therapeutic data up to november 2019 were analyzed. Data were obtained from medical records of hospital stay and subsequent consultations. Results We identified 50 patients who were diagnosed with one or more CAFs, with ages between 5 and 85 years (mean 59 years). 62% (n=31) were males. The great majority of patients had a single fistula (n=34, 68%), 11 patients had two fistulas (22%), 1 patient had 3 fistulas (2%) and 4 patients had multiple fistulas (8%). CAFs arose more frequently from the left anterior descending artery (n=27), followed by the right coronary (n=18), left circumflex (n=15), left main (n=5) and intermediate artery (n=2). The most frequent drainage site was the pulmonary artery (n=38). The majority of CAFs were incidentally found (n=32; 64%) and thought to have no significance for the patients' clinical status. As for the rest of the patients, CAFs were diagnosed during evaluation of: a heart murmur (n=7); exertional chest pain with no associated significant atherosclerotic coronary artery disease (n=7); exertional dyspnea (n=2); positive exercise stress test (n=1); NSTEMI and cardiac arrest (n=1). Regarding treatment, watchful waiting was the main approach (n=40; 80%). 3 patients had their CAFs closed during surgery for another heart condition (CABG/aortic valve replacement). In 1 patient, heart surgery was specifically conducted for fistula closure. 6 patients (12%) underwent fistula transcatheter closure. Conclusion CAFs are rare coronary anomalies and the majority has no clinical relevance, so watchful waiting is the commonest approach. When they are hemodynamically significant or symptoms/complications arise, surgical or transcatheter closure should be considered. This study describes the angiographic, clinical and therapeutic data of CAFs detected along the last 12 years in a single tertiary care center catheterization laboratory. Funding Acknowledgement Type of funding source: None

Empagliflozin Ameliorates Diastolic Dysfunction and Left Ventricular Fibrosis/Stiffness in Nondiabetic Heart Failure: A Multimodality Study

ObjectivesThe purpose of this study was to investigate the effect of empagliflozin on diastolic function in a nondiabetic heart failure with reduced ejection fraction (HFrEF) scenario and on the pathways causing diastolic dysfunction. BackgroundThis group demonstrated that empagliflozin ameliorates adverse cardiac remodeling, enhances myocardial energetics, and improves left ventricular systolic function in a nondiabetic porcine model of HF. Whether empagliflozin also improves diastolic function remains unknown. Hypothetically, empagliflozin would improve diastolic function in HF mediated both by a reduction in interstitial myocardial fibrosis and an improvement in cardiomyocyte stiffness (titin phosphorylation). MethodsHF was induced in nondiabetic pigs by 2-h balloon occlusion of proximal left anterior descending artery. Animals were randomized to empagliflozin or placebo for 2 months. Cardiac function was evaluated with cardiac magnetic resonance (CMR), 3-dimensional echocardiography, and invasive hemodynamics. In vitro relaxation of cardiomyocytes was studied in primary culture. Myocardial samples were obtained for histological and molecular evaluation. Myocardial metabolite consumption was analyzed by simultaneous blood sampling from coronary artery and coronary sinus. ResultsDespite similar initial ischemic myocardial injury, the empagliflozin group showed significantly improved diastolic function at 2 months, assessed by conventional echocardiography (higher e′ and color M-mode propagation velocity, lower E/e′ ratio, myocardial performance Tei index, isovolumic relaxation time, and left atrial size), echocardiography-derived strain imaging (strain imaging diastolic index, strain rate at isovolumic relaxation time and during early diastole, and untwisting), and CMR (higher peak filling rate, larger first filling volume). Invasive hemodynamics confirmed improved diastolic function with empagliflozin (better peak LV pressure rate of decay (–dP/dt), shorter Tau, lower end-diastolic pressure-volume relationship (EDPVR), and reduced filling pressures). Empagliflozin reduced interstitial myocardial fibrosis at the imaging, histological and molecular level. Empagliflozin improved nitric oxide signaling (endothelial nitric oxide synthetase [eNOS] activity, nitric oxide [NO] availability, cyclic guanosine monophosphate (cGMP) content, protein kinase G [PKG] signaling) and enhanced titin phosphorylation (which is responsible for cardiomyocyte stiffness). Indeed, isolated cardiomyocytes exhibited better relaxation in empagliflozin-treated animals. Myocardial consumption of glucose and ketone bodies negatively and positively correlated with diastolic function, respectively. ConclusionsEmpagliflozin ameliorates diastolic function in a nondiabetic HF porcine model, mitigates histological and molecular remodeling, and reduces both left ventricle and cardiomyocyte stiffness.

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.

Large symptomatic coronary artery fistulas draining to the left heart: transcatheter management.

Large coronary artery fistulas draining to the left heart structures causing heart failure are very rare. Interventional closure of such fistulas is limited to isolated reports, often in asymptomatic patients. Technical differences in these interventions include either deep arterial cannulation till their exit or transseptal arteriovenous circuit formation. Transcatheter closure of three large symptomatic fistulas in small children is reported.

A Case of Coronary Cameral Fistula: When and How to Intervene?

Coronary artery fistulas constitute a rare anomaly defined as an abnormal communication between a coronary artery and a great vessel or any cardiac chamber. The majority of these fistulas arise from the right coronary artery and the left anterior descending coronary artery; the circumflex coronary artery is rarely involved. We present an unusual case of a coronary artery fistula in a middle-aged woman who presented with symptoms of heart failure and abnormal auscultation. Echocardiography and conventional and computed tomography angiography showed that the coronary fistula originated from the left circumflex coronary artery and drained majorly into the right ventricle. Given the complex anatomy of the fistula, we managed it surgically rather than percutaneously. There were no complications early after surgery and at 1 year’s follow-up.

VP18.18: Prenatal detection and outcome of coronary artery fistulas: a case series and a systematic review of literature

VP18.18: Prenatal detection and outcome of coronary artery fistulas: a case series and a systematic review of literature

Septal Coronary Artery Fistula Following Left Bundle Branch Area Pacing.

Left bundle branch area pacing (LBBAP) is a novel pacing technique that requires the pacing lead to be screwed through the septum toward the left side of the interventricular septum ([1][1]). An 84-year-old woman underwent LBBAP for third-degree atrioventricular block. LBBAP was performed with a 5.6

Evaluation of Anomalous Coronary Arteries on 64 Slice Multidetector Computerized Tomographic Angiography

Introduction: Anomalous Coronary arteries is a well-known congenital entity with variable effects. The majority of such patients are asymptomatic but some can have adverse effects like ischemia and arrhythmia. Its association with Sudden Cardiac Death in young is established.
 Objective: To determine the frequency of ACA on MDCT in patients referred for coronary artery disease assessment and to determine the origin, course, and morphological variable of SCD of ACA on MDCT.
 Materials and Methods: The study was done in the Department of Cardiovascular Imaging at the Punjab Institute of Cardiology. A retrospective data of patients undergoing CTA for CAD between a period of Jan 2009 and Dec 2017 were analyzed for the presence of Anomalous Coronary Artery (ACA). All patients having anomalous origin from opposite coronary cusp and its course were included. The patients with myocardial bridging and coronary artery fistula were excluded.
 Results: Total patients analyzed with MDCT for CAD and graft assessment between Jan 2009 and December 2017 were 8028. Fifty-three patients were excluded because of poor image quality. Among these ACA were found in 166 (2.08%). Gender distributions were 126 (75.9%) males and 40 (24.09%) females, the mean age in years was 49.31 ± 13.23. The most common ACA was Right coronary artery 83 followed by Left Circumflex 44 (26.50%), Left Anterior Descending Artery 22 (13.25%), and Left Main Stem 17 (10.24%) respectively. Fifty-three (31.92%) patients had previously unknown ACA and were found to have ACA on MDCT and 82 (49.39%) patients were referred following ICA for the confirmation of ACA. The Inter-arterial course was predominant in RCA and Left Coronary Artery 97% and 77% respectively. A retro artic course was predominant (100%) in LCx. Seven patients had associated cyanotic heart disease with ACA. Two patients(one LAD and one RCA) had origin from the Main Pulmonary artery.
 Conclusion: MDCT is the imaging modality of choice for the evaluation of ACA. It can identify the origin of ACA from opposite coronary cusp and defines the malignant course of ACA for the potential risk of sudden cardiac death.