Coronary Fistula Research Articles

High-Risk Anatomic Subsets in Hypoplastic Left Heart Syndrome

Despite overall improvements in outcomes for patients with hypoplastic left heart syndrome, there remain anatomic features that can place these patients at higher risk throughout their treatment course. These include severe preoperative obstruction to pulmonary venous return, restrictive atrial septum, coronary fistulae, severe tricuspid regurgitation, smaller ascending aorta diameter (especially if <2 mm), and poor ventricular function. The risk of traditional staged palliation has led to the development of alternative strategies for such patients. To further improve the outcomes, we must continue to diligently examine and study anatomic details in HLHS patients.

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.

A percutaneous treatment of giant right coronary fistula causing heart failure: a safe and effective procedure.

A percutaneous treatment of giant right coronary fistula causing heart failure: a safe and effective procedure.

Anomalous coronary artery from the pulmonary artery diagnosed in adulthood: a case series on variations of coronary anatomy and the diagnostic value of cardiac magnetic resonance imaging

BackgroundAnomalous coronary artery from the pulmonary artery is a rare congenital disorder with high mortality rates in infancy. Adult cases can present with life-threatening arrhythmias and sudden cardiac death.Case summaryWe report three cases of adults with anomalous pulmonary origin of each of the main coronary branches. The first patient with an anomalous left coronary artery from the pulmonary artery presented with an out-of-hospital cardiac arrest. The second patient with an anomalous circumflex artery from the pulmonary artery was evaluated for a bicuspid aortic valve and a suspected coronary fistula but was otherwise asymptomatic. The third patient with an anomalous right coronary artery from the pulmonary artery presented with anginal symptoms. In all cases, the diagnosis was made by cardiac computed tomography or coronary angiography. Cardiac magnetic resonance imaging was performed in all patients to guide clinical decision making on surgical or non-invasive management. All patients underwent surgical repair. In two patients, a dual coronary artery system was restored by aortic reimplantation of the anomalous coronary artery. In one patient, aortic reimplantation was unsuccessful due to poor vessel quality and the anomalous coronary artery was ligated. Clinical follow-up during 1.8–9.7 years did not show any cardiovascular complications and all patients are currently alive and asymptomatic.DiscussionAnomalous coronary artery from the pulmonary artery can have various clinical presentations in adulthood. Cardiac magnetic resonance imaging is a useful modality to guide selection of patients who might have symptomatic or prognostic benefit from surgical repair.

Transcatheter closure of a rare giant aneurysm in coronary right ventricle fistula associated with ventricular septal dissection.

Transcatheter closure of a rare giant aneurysm in coronary right ventricle fistula associated with ventricular septal dissection.

Left/right coronary artery-left ventricular fistulae with color flow image observed during transthoracic echocardiography.

Left/right coronary artery-left ventricular fistulae with color flow image observed during transthoracic echocardiography.

Double right coronary artery with fistula to the right atrium and mitral insufficiency: A case report.

Introduction and importanceCoronary artery abnormalities are uncommon and mostly asymptomatic. The combination of double right coronary artery (RCA) with a fistula and valvar deformity is very rarely reported in the literature. However, it is important to identify these deformities as they have relatively high complication rates.Presentations of caseA 47-year-old male came with chest pain that radiated to the lower jaw. ECG showed equivalent changes. Blood tests including troponin were within normal range. However, echocardiogram showed a severe mitral valve regurgitation with anterior leaflet prolapse and hypokinesia of the ventricular wall. Coronary angiogram showed a double RCA with a complete block in the main RCA and a fistula to the right atrium (RA). The left coronary system showed atherosclerosis in left anterior descending artery (LAD) and circumflex artery (CX). Surgical treatment, including the repair of the RCA-RA fistula, replacement of mitral valve and coronary artery bypass grafting (CABG) were performed. The patient had no complications in the follow-ups.DiscussionCoronary fistulas may be congenital or acquired malformations. Their treatment depends on the symptoms, origin, size and the receiving chamber. Furthermore, double RCA is debatable whether the rate of atherosclerosis and other cardiac abnormalities are increased with this anomaly. The surgeon must keep in mind these rare anomalies before cardiac operations.ConclusionDouble RCA might accompany other deformities which are important to detect before intervention. More studies are required to decrease complications and have better outcomes.

P167 ECG ABNORMALITIES AND DOUBLE CORONARY FISTULA

Abstract Coronary artery fistula (CAF) is defined as anomalous communication between coronary arteries and cardiac chamber or a major thoracic vessel. CAF are a rare coronary anomaly, mostly congenital, first described by Krause in 1856. In literature the incidence in general population is approximately 0,002%. Detection of CAF during coronary angiography is usually accidental. In 50% of cases CAF originate from right coronary artery, in 30% they originate from LAD, while in the rest of the percentage CAF originate from left circumflex artery. CAF drain into low–pressure chamber (right ventricle or right atrium, superior Vena Cava or pulmonary artery). We can distinguish CAF into little or medium sized, usually with silent clinical course, and large sized CAF, with variable clinical signs, depending on the extent of the shunt and on the hemodynamic overload of the receiving chamber. We describe the case of a 57 y.o woman with hypertension, admitted for femur fracture. ECG showed bifasic T waves in the anterior leads, already described in a previous ECG. Normal systolic function and no valvular defect were found on the echocardiogram. Patient was asymptomatic. Coronary angiography documented normal coronary arteries, with a double coronary fistula: the first from a septal branch of posterior descending and the second one from distal branches of the first diagonal. Even if CAF have often a favorable clinical course with no relevant consequences for the patient, it’s crucial to obtain more information about their functional implication and their anatomic connections. Indeed, rare cases of sudden cardiac death have been described in patients with CAF involved in myocardial ischemia based on the theft syndrome mechanism. Echocardiographic evaluation of the patient to detect associated congenital abnormalities, pressure overload of the receiving chambers and the extent of the shunt on the coronary angiography are crucial for the proper management of CAF. In the case described above we decided to optimize therapy adding beta–blocker (to reduce the overload caused by the two coronary fistula).

Surgical Correction of Coronary Arteriovenous Fistula in the Newborn Period

Surgical Correction of Coronary Arteriovenous Fistula in the Newborn Period

Surgical repair for left coronary artery-right atrium fistula with giant coronary aneurysm

BackgroundCoronary artery fistula is a rare coronary anomaly which is defined as a communication between coronary artery and other heart chambers or vascular structures. The coronary artery which supply the fistula with blood can dilated, as a consequence, coronary aneurysm developed.Case introductionCoronary artery fistula is frequently asymptomatic in its early stage, here we report a 26-year-old woman with left coronary artery fistula and left coronary artery aneurysm who presented in our hospital with dyspnea, fatigue and palpitation. The orifice of fistula was closed by continuous suture via right atriotomy. The wall of the aneurysm and enlarged LCA were partially resected along its longitudinal axis so that we can reduce the diameter of LCA to approximately normal.ConclusionThis technique provides a safe method for surgical repair of the giant coronary artery aneurysm with CAF.

Giant Interventricular Septal Dissecting Aneurysm Resulting From Congenital Coronary Fistula.

HomeCirculation: Cardiovascular ImagingVol. 15, No. 5Giant Interventricular Septal Dissecting Aneurysm Resulting From Congenital Coronary Fistula No AccessCase ReportRequest AccessFull TextAboutView Full TextView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplementary MaterialsNo AccessCase ReportRequest AccessFull TextGiant Interventricular Septal Dissecting Aneurysm Resulting From Congenital Coronary Fistula Lei Zhi Ku, MD, Juan Xia, MD, Hang Lv, MD, Lai Chun Song, MD and Xiao Jing Ma, MD Lei Zhi KuLei Zhi Ku Department of Radiology (L.Z.K.), Wuhan Asia Heart Hospital, Hankou District, P.R. China. Search for more papers by this author , Juan XiaJuan Xia Department of Echocardiography (J.X., X.J.M.), Wuhan Asia Heart Hospital, Hankou District, P.R. China. Search for more papers by this author , Hang LvHang Lv Department of Cardiac Function, Wuhan Asia General Hospital, HanYang District, P.R. China (H.L.). Search for more papers by this author , Lai Chun SongLai Chun Song Department of Cardiac Surgery (L.C.S.), Wuhan Asia Heart Hospital, Hankou District, P.R. China. Search for more papers by this author and Xiao Jing MaXiao Jing Ma Correspondence to: Xiao Jing Ma, MD, Department of Echocardiography, Wuhan Asia Heart Hospital, No. 753 Jinghan Rd, Hankou District, Wuhan 430022, P.R.China. Email E-mail Address: [email protected] https://orcid.org/0000-0002-6749-0898 Department of Echocardiography (J.X., X.J.M.), Wuhan Asia Heart Hospital, Hankou District, P.R. China. Search for more papers by this author Originally published28 Apr 2022https://doi.org/10.1161/CIRCIMAGING.121.013861Circulation: Cardiovascular Imaging. 2022;15FootnotesSupplemental Material is available at https://www.ahajournals.org/doi/suppl/10.1161/CIRCIMAGING.121.013861.For Sources of Funding and Disclosures, see page 335.Correspondence to: Xiao Jing Ma, MD, Department of Echocardiography, Wuhan Asia Heart Hospital, No. 753 Jinghan Rd, Hankou District, Wuhan 430022, P.R.China. Email [email protected]com

TCTAP C-018 “Double Steal Phenomenon”: A Rare Case of Coronary Fistula From LAD to Main Pulmonary Artery in the Presence of SVG to LAD

TCTAP C-018 “Double Steal Phenomenon”: A Rare Case of Coronary Fistula From LAD to Main Pulmonary Artery in the Presence of SVG to LAD

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.

Prevalence of coronary anomalies detected by computed tomography at the Instituto Nacional Cardiovascular- INCOR

: To determine the prevalence of coronary anomalies (CA) in patients evaluated by 64-detector computed tomography (CT) at the Instituto Nacional Cardiovascular in Peru between 2016 and 2020. Retrospective observational study, coronary artery CT scans of 1486 patients were performed on a 64-detector row CT scanner and reviewed in search for coronary anomalies. The prevalence of CA detected by CT was 4.71% (70 cases) of which 64.3% were male. Abnormalities of origin were the most frequent, of which the origin of a coronary artery from the opposite coronary sinus was the most common (48.6%), with the right coronary being the main anomalous artery (31%), and the main path was interarterial (31%). Anomalous origin of the left main coronary from the pulmonary artery was found in 5 patients. Among the anomalies of the intrinsic coronary arterial anatomy the most frequent was the double left anterior descending artery (10%). Coronary fistulas accounted for 11.4% of cases. The prevalence of CA detected by 64-detector CT in a Peruvian institute was 4.71%. The most frequent coronary anomaly was the origin of the right coronary artery from the left coronary sinus with interarterial trajectory.

Right Coronary Artery Fistulae Draining into Right Atrium: A Case Report

We report the case of a 16-year-old young girl seen for precordial pain and stage II NYHA dyspnea. Clinical examination found a maximal systolodiastolic murmur in the left subclavicular. Lateral Q waves were noted on the electrocardiogram and echocardiography revealed a right coronary fistula draining in right atrium. CT scan confirmed the diagnosis. Patient was addressed to a specialized center for percutaneous closure of the fistula. In case of signs indicating coronary artery disease, the search for coronary anomalies should be systematic in children by using EKG and transthoracic echocardiography. In case of doubt, a second imaging such as the multislice Ct scan is performed. Coronary angiography has a dual diagnostic and therapeutic interest. The indications for treatment depend on the symptoms and the results of ischemia tests.

Coronary Cameral Fistula

Coronary Cameral Fistulas (CCFs) are rare arteriovenous malformations, defined as a connection between a coronary artery and a cardiac chamber or any segment of the systemic or pulmonary circulation. These may be congenital or acquired, and show a low incidence in both angiographic studies, and the general population. The presentation of CCFs varies depending upon their size and location. These can be majorly asymptomatic or show symptoms and complications like congestive heart failure, myocardial infarction, and bacterial endocarditis. Although percutaneous closure with embolisation can be done, surgical closure of CCF is a gold standard of treatment. The authors reported a case of a 57-year-old male who presented with exertional chest pain and dyspnea. Coronary angiography revealed the presence of dilated tortuous Left Main Coronary Artery (LMCA), Left Anterior Descending artery (LAD), Left Circumflex artery (LCX) and CCF between LAD to Right Ventricle (RV), Obtuse Marginal (OM) to RV and Posterior Left ventricular Branch (PLB) to RV. No significant obstructive coronary artery disease was present. Coronary artery calcium score was 15. The patient was managed conservatively with antiplatelets, statin, and heparin and responded well to the treatment.

Prevalence and characteristics of coronary artery anomalies in an adult population in Tunisia

Congenital coronary anomalies occur rarely and concern 0.16 to 1.3% of the population undergoing coronary angiography. Although generally benign, some may be responsible for dreadful complications such as sudden death, syncope and acute coronary syndromes. We report our experience through a population of 6358 patients. This is a retrospective study screening a population of 6358 patients who underwent a coronary angiography procedure at Mongi Slim Hospital, La Marsa, Tunisia between 01/01/2009 and 22/03/2016. All patients had in addition a CT coronary angiography and the identification of these congenital anomalies of the coronary arteries was established according to the Angelini classification. Of the 6358 patients undergoing coronary angiography, 13 (0.20%) patients (7 women and 6 men) had congenital coronary artery anomalies. The average age of these patients is 51.3 years. Coronary angiography was indicated following ACS without persistent ST segment elevation in 2 patients, stable angina in 9 patients and etiological assessment of dilated cardiomyopathy in 2 patients. Origin abnormalities were the most common congenital anomalies of the coronary arteries ( n = 9, 69.2%). An inter-aorto-pulmonary pathway was associated in 3 cases and treated by surgical revascularization. A single right coronary has been present in a patient. Three cases of coronary fistulas have been reported: a coronary-pulmonary fistula (between the LM and the trunk of the pulmonary artery) without significant shunt and 2 cases of coronary-cameral fistulas. According to our study, the incidence of congenital coronary anomalies in Tunisia is 0.20%. Although the majority of these rare abnormalities are “benign”, their identification is essential in view of the existence of “malignant” abnormalities with sometimes fatal clinical impact and in patients who can benefit from coronary angioplasty or heart surgery.

Surgical management of an aneurysmal coronary cameral fistula to the right atrium

Coronary artery aneurysm and coronary cameral fistula are both often incidentally discovered, and uncommon diagnoses. A coronary artery aneurysm is defined as being 1.5x the size of the adjacent normal coronary artery, while a coronary cameral fistula is a coronary artery that has an abnormal tract directly into a chamber of the heart. In this case report we describe the case of a 72-year-old female who was discovered to have an aneurysmal branch of her right coronary artery fistulized to her right atrium. The fistula had a serpiginous tract and in the midportion of the tract there was a giant aneurysm (3.4 x 3.3 x 3.0 cm) before emptying into the posterior aspect of the right atrium. The aneurysmal aberrant coronary artery was repaired by oversewing the afferent and efferent limbs from the inside. The aneurysm walls were then oversewn. This case demonstrates a unique pathology that was managed with surgical intervention where no standard therapy exists.

Prevalence and Characteristics of Acquired Coronary Fistulas After Successful Revascularization of Chronic Total Occlusion.

Background and Objectives: Acquired coronary fistulas (ACFs) are rare coronary artery abnormalities in patients with chronic total occlusion (CTO). It has been found after revascularization, and it may cause fluster during the CTO percutaneous coronary intervention (CTO PCI). How to distinguish between ACFs and coronary perforation (CP) is very important for CTO operators. Chronic total occlusion reopening may reveal the microchannel of the adventitial vascular layers. Some of ACFs have been seen after revascularization. This study aimed to investigate the characteristics of ACFs after successful CTO PCI.Methods: The clinical and procedural characteristics, medical history, and findings in electrocardiography (ECG), echocardiography, and coronary angiography were collected from 2,169 consecutive patients undergoing CTO PCI between January 2018 and December 2019 and analyzed retrospectively.Results: About 1,844 (85.02%) underwent successful CTO PCI with complete revascularization. Acquired coronary fistulas were found in 49 patients (2.66%): the majority of patients with ACFs were men (81.63 vs. 60.78%; p = 0.016) and younger (62.8 vs. 66.69 years; p = 0.003), and had a history of myocardial infarction (MI) or Q-wave (69.39 vs. 54.21%; p = 0.035); 38 (77.55%) patients had multiple fistulas (≥3), and ACFs affected multiple branches of the CTO vessel (≥3) in 29 (59.18%) patients. None had pericardial effusion, tamponade, and hemodynamic abnormality before or after PCI.Conclusion: Acquired coronary fistulas after successful CTO PCI are mainly present in young and male patients with a history of MI, and they often involve multiple fistulas and distal CTO vessels.

Coronary Interventions in Pediatric Congenital Heart Disease

Coronary artery lesions represent rare conditions in pediatric congenital heart disease and mainly include coronary artery stenoses (CAS) or coronary artery fistulae (CAF). Due to the small vessel size, pediatric percutaneous coronary interventions (PCI) are demanding and studies concerning long-term results are missing. In this retrospective study, we analyzed indications, procedural details, and post-procedural outcomes in pediatric patients who underwent PCI in our institution. For CAS treatment, procedural success was defined as efficient coronary revascularization with a significant improvement of coronary perfusion. CAF treatment was considered successful, when no residual shunt was detectable. From 1995 to 2020, 32 pediatric patients aged ≤ 18 years received interventional treatment for CAS (n = 24/32) or CAF (n = 8/32). Reasons for CAS were post-surgical (n = 15/24) or post-transplant (n = 9/24). Interventional treatment strategies included coronary angioplasty (20/43), stent placement (10/43), and a combination of both (13/43). In-hospital mortality occurred in 6/24 patients and late mortality in 5/24 patients leading to an overall 5-year survival of 62.5%. Early mortality mainly occurred due to post-ischemic myocardial failure. CAF occlusion was performed using coil embolization (n = 3), placement of vascular plugs (n = 3), a combination of both (n = 1), or a combination of coil embolization and a covered stent (n = 1). Treatment of coronary fistulae was successful in all patients with excellent post-procedural results and no follow-up death. PCI in pediatric patients with congenital heart disease can be performed safely and effectively. However, the overall 5-year survival probability of patients with CAS is reduced due to severe ischemic myocardial damage.