Coronary-pulmonary Artery Fistula Research Articles

A case of aneurysm associated with bilatetal coronary-pulmonary artery fistula and left vnetricular cardiac diverticulum

A case of aneurysm associated with bilatetal coronary-pulmonary artery fistula and left vnetricular cardiac diverticulum

Ruptured aneurysm of coronary artery-to-pulmonary artery fistula

A 69-year-old lady was discovered unconscious. Computed tomography showed pericardial effusion and a coronary artery aneurysm of 25 mm in diameter in front of the main pulmonary artery. Emergency surgery revealed a coronary-pulmonary artery fistula and coronary aneurysm surrounded by a large hematoma. The inflow and outflow of the fistula were closed, and no cardioplegic leakage was noted. Postoperative angiography showed residual fistulas that were successfully closed by transcatheter embolization.

Multiple Anomalous Systemic-Pulmonary Connections and Coronary-Pulmonary Artery Fistula Associated with Large Aneurysms in an Elderly Woman

We report the repair of a coronary artery fistula arising from the right coronary artery draining into the right pulmonary artery associated with multiple systemic-pulmonary connections.

Successful surgical repair of a giant coronary-pulmonary artery fistula: role of magnetic resonance imaging

A 69-year-old woman was referred for the evaluation of an abnormal shadow at the left cardiac border on her chest X-ray films ( Panel A ). A Levine II/VI continuous murmur was heard at the upper left parasternal area on physical examination, while coronary angiogram (CAG) subsequently revealed the presence of a coronary-pulmonary artery fistula (CPAF) …

A case report of coronary-pulmonary artery fistula with giant aneurysm

A case report of coronary-pulmonary artery fistula with giant aneurysm

A Large Coronary‐Pulmonary Artery Fistula in a Cyanotic Patient Leading to Severe Biventricular Dysfunction and Heart Failure

In cases of pulmonary atresia (PA) with ventricular septal defect (VSD), the commonest source of pulmonary blood flow is via major aortoplumonary collaterals. Collaterals may also arise from the coronary arteries and the reported prevalence of such coronary-pulmonary artery fistulas (CPAF) in PA with VSD is 10%. However gross congestive heart failure (CHF) and ventricular dysfunction is extremely rare in such cases. We report a 17-year-old male with PA with VSD and a large CPAF from the anterior right aortic sinus connecting to the left pulmonary artery, who presented with severe CHF. The left anterior descending and the right coronary artery both arose from the proximal part of the CPAF, possibly leading to extensive coronary steal and biventricular dysfunction.

Gender-related differences in octogenarians with congenital coronary artery fistula: a report of two cases and a review

To highlight gender-related differences in octogenarians with a congenital coronary artery fistula (CAF). We present two elderly female patients with a congenital fistula, a septuagenarian and a nonagenarian, and review the world literature between 1954-2010. The septuagenarian patient presented with easy fatigability and the nonagenarian patient with acute myocardial infarction contralaterally to the fistula. Coronary angiography (CAG) demonstrated a coronary-pulmonary artery fistula (CPF). The nonagenarian patient underwent percutaneous coronary intervention of the right coronary artery. CAG revealed a CPF associated with a huge multiple aneurysmal formation. Data from 57 mainly symptomatic patients with a mean age of 75.3years (range 70-87years) were collected. The cohort was subdivided into female (mean age 84.3years) and male (mean age 75.2years) subgroups and compared with each other. Multi-origin (bilateral and multilateral) was prevalent in females, 40% versus 12% in males. Aneurysmal formation was found in females and males in 40% and 18%, respectively. Ethnicity was 65% Caucasian and 35% Asian. Multi-origin fistulas were prevalent in the Asian (45%) compared with the Caucasian (11%) subset. A septuagenarian and a nonagenarian female patient with congenital CAF are presented. On reviewing the literature, important differences were found between elderly females and males with congenital CAF.

Coronary-Pulmonary Artery Fistula

It is presented the case of a 46 years old man who was admitted with a diagnosis of myocardial infarction. The patient reported that since 16 years old, he has experienced epidodes of sweating, and syncope feeling in times of emotional stress. He consulted by, intensity 8/10, more than 30 minutes with BP 96/54 mmHg, HR 90/mim. The echocardiogram shows ST elevation in DI, AVL, V2 to V6, so it is carried out coronary angiography and angiosplasty with endograft to left anterior descending artery in the middle third and it is evidenced as finding the presence of coronary-pulmonary artery fistula (2). Coronary artery fistula was first described by Krause in 1865, but it was Trevor who in 1912 published about the subject for the first time, describing the findings at autopsy, where the right coronary artery was connected with the right ventricle (1). This is an abnormality of the coronary circulation in which one of the coronary arteries communicates through one or more branches, the trunk of the

Successful percutaneous coil embolization of coronary–pulmonary, –carotid, and –internal mammary artery fistulas

We herein describe a 57-year-old man with coronary-pulmonary artery fistulas that had abnormal connections between the left common carotid artery and the left internal mammary artery. The patient was treated with percutaneous coil embolization using antegrade (via the coronary artery) and retrograde (via the pulmonary artery) approaches. Coronary artery fistulas have diverse anatomical variations, and it is important to thoroughly evaluate the anatomy before beginning any mode of treatment, surgical or endovascular. In the case reported herein, multislice computed tomography played a pivotal role in the preprocedure evaluation.

Histopathologic Characteristics of a Coronary-pulmonary Artery Fistula with a Coronary Artery Aneurysm

Here, we report a case of a 59-year-old woman with a coronary-pulmonary artery fistula with a concomitant coronary artery aneurysm, which comprised an anomalous coronary artery originating at the right coronary cusp, an aberrant branch of the left anterior descending artery, and a coronary artery aneurysm draining into the main pulmonary artery. Histopathologically, non-dilated anomalous coronary artery showed the preservation of internal elastic lamina and medial smooth muscle cell phenotype which lacked in the aneurysmal wall. Thus, the disrupted internal elastic lamina and phenotypic change of medial smooth muscle cells might contribute to aneurysm formation in a coronary-pulmonary arterial fistula.

Coronary to pulmonary artery fistula: morphologic features at multidetector CT

The objective of this study is to evaluate the incidence and morphologic features of coronary-pulmonary artery fistulas (CPAF) by multidetector computed tomography (MDCT). From 2006 to 2008, 5,372 patients underwent ECG-gated cardiac CT scans using 64-slice MDCT at our institute. Among them, 17 cases of CPAF were detected (M:F=14:3, mean age=63years). Chief complaints of patients were chest pain (n=12), abnormal cardiac test (n=3), known coronary artery disease (n=1), and known CPAF (n=1). We retrospectively analyzed the morphologic features of CPAF, such as origin vessels, draining site, fistula size, and aneurysmal sac. Five cases underwent coronary angiography (CAG) and correlated with MDCT findings. Incidence of CPAF was 0.32% by MDCT. The origin of CPAF was the left coronary artery in five (29.4%), the right coronary artery in two (11.8%) and both coronary arteries in ten cases (58.8%). In regard to the diameter of the detected fistula, the diameter of the largest vessel excluding aneurysm was variable from less than 2 to 5.7mm. Five patients (29.4%) had a fistula that was shown as one vessel that could be traced, one patient (5.9%) was shown as two vessels, and eleven patients (64.7%) were shown as innumerable multiple vessel networks. Five cases were associated with aneurysm (29.4%). Fistulas were located primarily in the left anterolateral aspect of the pulmonary trunk (82.3%) and mostly the drainage site was the left lateral side of the pulmonary trunk (82.3%). CAG was performed in five cases and revealed identical findings to MDCT. In conclusion, coronary-pulmonary artery fistula is more frequently found than anticipated on MDCT. CPAF is supplied by either single or both coronary arteries and drains to the left side of the pulmonary trunk. It is typically located in the anterolateral aspect of the pulmonary trunk. Sometimes CPAF is associated with aneurysms.

Pulmonary artery dissection associated with multiple coronary–pulmonary artery fistulae

We experienced the surgical repair of an extremely rare pulmonary artery dissection without pulmonary hypertension. The patient had multiple coronary-pulmonary artery fistulae, which presumably caused pulmonary artery dissection. The surgical treatment included the closure of the multiple coronary fistulae and the resection of the intimal flap in the main pulmonary artery. The patient recovered uneventfully.

Giant Coronary Artery Aneurysm With Pulmonary Artery Fistula in a Patient on Chronic Hemodialysis

The combination of coronary artery aneurysm and pulmonary artery fistula is extremely rare and its common cause is atherosclerosis. A 61-year-old woman presented with a giant coronary artery aneurysm with pulmonary artery fistula and intramyocardial calcifications of the left ventricle associated with progressive atherosclerosis due to chronic hemodialysis. The coronary artery aneurysm was resected under cardiopulmonary bypass because of hemodynamic instability due to restrictive cardiac dysfunction. The patient's restrictive cardiac dysfunction was improved after aneurysm resection. Surgical resection should be considered for giant coronary artery aneurysm with restrictive cardiac dysfunction.

Coronary artery–pulmonary artery fistula in a heart-transplanted patient

A 64-year-old-man underwent routine elective right-left heart catheterization, 1 year after cardiac transplantation for terminal ischaemic cardiomyopathy. Surprisingly, selective coronary angiography disclosed coronary-pulmonary artery fistula with three feeding vessels originating from the proximal right coronary artery, the proximal portion of the left anterior descending artery, the circumflexus artery, and the left main coronary artery, draining into the pulmonary trunk. For this particular patient, without any significant cardiac complaints or symptoms, with normal cardiac dimensions and haemodynamic findings, a conservative approach was decided on.

Coronary-pulmonary Artery Fistula with Anomalous Vessels Arising from the Right Coronary Sinus Detected by 64-MDCT

We describe a case of aneurysmal coronary-pulmonary artery fistula and a communicating anomalous vessel arising from the right coronary sinus that was clearly demonstrated by 64-multidetector row computed tomography (MDCT). MDCT angiography was more useful than cardiac catheterization for planning the surgical strategy.

Multi-slice computed tomography diagnosis of a coronary–pulmonary artery fistula

Coronary–pulmonary artery fistula is an uncommon congenital cardiac anomaly. Most coronary–pulmonary artery fistulas are clinically and haemodynamically non-significant and they are usually found incidentally. We report a case of a woman admitted to our hospital for symptoms of myocardial ischemia in which MSCT allowed us to do the right diagnosis, with high-quality images and in a non-invasive way.

Myocardial ischemia due to a large coronary–pulmonary fistula with plexus-like morphology

Congenital coronary-pulmonary artery fistula is a rare anomaly. We report the case of a coronary-pulmonary artery fistula with plexus-like morphology connecting the left main stem and proximal segments of the left anterior descending and circumflex coronary arteries to the main pulmonary artery in a 69-year-old woman. It caused inducible ischemia as revealed by myocardial perfusion tetrafosmin scintigraphy (Tc-99m SPECT). To our knowledge, no case of a large plexus-like coronary-pulmonary artery fistula from the very proximal left coronary artery has been reported. Furthermore, only a few cases report scintigraphic demonstration of severe ischemia in such a coronary anomaly.

Extracardiac Venous Heterotaxy Syndrome

A 20-year-old man was referred for the assessment of palpitations and associated dyspnea during exertion. He had no other associated cardiovascular symptoms. Physical examination revealed a healthy male with stable vital signs and a normal cardio respiratory examination. ECG, (Figure 1A), chest x-ray (Figure 1B), and blood counts as well as electrolyte panel were normal. Figure 1. A, Twelve-lead ECG with normal sinus rhythm, cardiac axis, and normal intervals. B, Chest x-ray postero-anterior and lateral views showing normal cardiac silhouette, but gastric air noted on the right subcostal in this case compared with the usual location. Transthoracic echocardiography revealed a dilated coronary sinus (Figure 2); in addition, a persistent left superior vena cava was noted (Figure 3). A small coronary-pulmonary arterial fistula was noted (Figure 4). Two-dimensional subcostal echocardiography view demonstrated absence of the hepatic portion of the inferior vena cava with the hepatic veins draining directly into the right atrium (interrupted inferior vena cava). The right suprasternal view revealed venous flow into the right superior …

Surgical repair of triple coronary-pulmonary artery fistulae with associated atrial septal defect and aortic valve regurgitation

Coronary arterio-venous fistulae are congenital or acquired cardiac anomalies whereby blood bypasses the myocardial capillary network. Involvement of all three coronary arteries is rare. There is a wide variation in the clinical presentation and the actual morphological malformations. The mainstay of treatment is either surgical or coil embolisation. Associated congenital malformations can be dealt with during the same surgical setting if required. We present a case of coronary arterio-venous fistula involving all three coronary arteries with associated atrial septal defect and acquired aortic regurgitation, all of which were dealt with surgically with good surgical outcome.

Findings of Bilateral Coronary to Pulmonary Artery Fistula in 64-Multislice Computed Tomographic Angiography

A 63-year-old man, who underwent conventional coronary angiography, because of a finding of a confusing vascular structure, was referred for 64-multislice spiral computed tomography (MSCT). His MSCT showed bilateral coronary-pulmonary artery fistula from both right and left coronary arteries via a dilated fistulous vascular malformation. Considering its reasonably high spatial and temporal resolutions, MSCT is regarded as a valuable technique to clarify the diagnosis in incidentally found equivocal cases of coronary fistula in conventional coronary angiography.