Coronary-pulmonary Fistula Research Articles

Coronary-pulmonary fistula with focal aneurysm of the diagonal artery

Coronary-pulmonary fistula with focal aneurysm of the diagonal artery

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 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.

Coronary-Pulmonary Artery Fistula Recanalization on Coronary Computed Tomography Angiography Images.

Coronary computed tomography angiography (CCTA) is a non-invasive diagnostic method used (apart from the diagnosis of coronary artery disease) in the diagnosis of malformations of the coronary circulation and monitoring the effects of their treatment. In this paper, the authors present the case of recanalization of the coronary-pulmonary fistula, which was surgically closed in the past. This case highlights that follow-up CCTA after surgical treatment of coronary artery fistula should be performed in every patient. The recommendations regarding the frequency of such follow-up should be made.

Primary aldosteronism and coronary-pulmonary artery fistula: coincidence or causal link? A case report and literature review

Background: Primary aldosteronism (PA) is the most frequent form of potentially reversible hypertension and coronary-pulmonary fistulas are increasingly recognized during routine coronary angiography or multidetector computed tomography for analysis of chest pain in hypertensive patients. Aldosterone hypersecretion has been associated with endothelial proliferation and pathological remodeling of the heart and arteries, though coronary artery fistulas have never been reported in patients with PA. Case presentation: The authors report the first case of PA with dilated cardiomyopathy unusually associated with electrocardiographic changes after normalization of hypokalemia and with the finding of a coronary-pulmonary fistula during coronary angiography. The clinical presentation and our diagnosis and treatment decision-making in the COVID-19 era are discussed below. Conclusions: Our case suggests a potential link between hypertensive patients with coronary artery fistulas and PA.

The role of the fractional flow reserve in the coronary steal phenomenon evaluation caused by the coronary-pulmonary fistulas: case report and review of the literature

BackgroundCongenital coronary-pulmonary fistulas (CPFs) are commonly unilateral; however, bilateral and multilateral fistulas are relatively rare. The steal phenomenon aroused from bilateral or multilateral CPFs, and was uncertain and seldom reported. We possess a new tool to assess the hemodynamic significance of coronary artery fistulas. This study aimed to describe the clinical presentation, diagnostic modalities, and management of the coincidentally detected congenital bilateral CPFs.Case presentationA case of a 52 year-old female with 10 years history of typical palpitations and chest tightness was presented. The selective coronary arteriography showed a right dominant coronary circulation without significant stenosis; however, with anomalous vessels originating from the proximal right and left anterior descending coronary arteries, draining into the pulmonary artery through a plexus of small vessels. We introduced the fractional flow reserve (FFR) to evaluate the hemodynamic significance of CPFs. The patient was successfully treated with coil embolization.ConclusionsWe presented the case of a female with typical palpitations and chest tightness due to the steal phenomenon that aroused from bilateral CPFs. The fistulas were safely and successfully closed by coil embolization. We showed a new tool for the sophisticated evaluation of the hemodynamic significance of CPFs using FFR measurement and temporary occlusion of the fistula with a standard balloon. FFR could be a promising means for the treatment of decision making of the CPFs.

Ventricular tachycardia, rheumatic heart disease, and bilateral coronary pulmonary artery fistula: A rare association

Coronary-pulmonary artery fistulas are rare congenital or acquired anomalies of the coronary artery that may originate from any of the three major coronary arteries and drain into the right-sided cardiac chambers and or large vessels draining into the pulmonary circulation. A triple combination of ventricular tachycardia, rheumatic heart disease, and bilateral coronary pulmonary fistula is a rare association. A rare combination of observations was detected in a single patient with three distinct etiopathogenesis that is not described in the literature.

Embolization of the coronary-pulmonary fistula of the circumflex artery in a patient with a myocardial infarction and an implanted pacemaker

Patient’s history with an implanted pacemaker and a myocardial infarction with a coronary­pulmonary fistula of circumflex artery was analyzed. The article discusses the difficulties of diagnosing this pathology and the possibilities of its curative treatment, as well as the experience of its management in the Clinics of Samara State Medical University.

AB021. LA06. Management of the incidentally detected prevascular mass

: Mediastinal lesions include a variety of benign and malignant diseases. Half of them are located in the anterior mediastinum and thymic lesions are largely responsible for anterior mediastinal lesions. With the increasing use of chest CT imaging in clinical practice and lung cancer screening, asymptomatic incidental anterior mediastinal lesions have become more frequently detected. Three studies so far have reported the prevalence of incidentally detected anterior mediastinal lesions on chest CT scan. The Early Lung Cancer Action Project (ELCAP) study reported a prevalence of 0.45% [95% confidence interval (CI), 0.32–0.60%; 41 of 9,263 participants] among middle- to old-aged smokers (median, 65 years). The Framingham Heart Study reported a prevalence of 0.89% (95% CI, 0.59–1.35%; 23 of 2,571 participants) in a similar population (median, 59 years) except for non-smoking in half of the participants. Lastly, among 56,358 healthy participants (mean age: 52.4 years) who underwent a low-dose chest CT scan as part of their health checkups, the prevalence was 0.73% (95% CI, 0.66–0.80%). The distribution of pathologies in anterior mediastinal lesions is different according to age and gender. Considering that incidental anterior mediastinal lesions are primarily encountered on screening chest CT scan in 50–70s, thymic malignancy such as thymic epithelial tumors is a main concern for the incidental lesions. In the ELCAP study, among the 41 lesions, five lesions which were larger than 3 cm were resected, and thymic epithelial tumor was identified in four of the five lesions, whereas 5 of 25 lesions (20%) smaller than 3 cm increased at 1 year. In the Framingham Heart Study, none of the 23 lesions were resected, and 6 of 8 lesions (75%) had increased on a follow-up CT scan over a median follow-up of 6.5 years. In the asymptomatic subjects who underwent chest CT scan for health checkups, 51 of 413 lesions (12.3%) had a confirmatory diagnosis: 76.9% (39 of 51) were benign (32 thymic cysts, 4 bronchogenic cysts, 1 mature teratoma, 1 thymolipoma, and 1 coronary-pulmonary fistula); and 23.1% (12 of 51) were malignant (6 thymomas, 5 thymic carcinomas, and 1 non-small cell lung cancer). Conservative management with follow-up is recommended for the incidental lesions. Nevertheless, a regular follow-up may not resolve all problems, as a long-term follow-up is required to detect any increase or decrease in lesion size and neither interval growth nor a lack of growth during follow-up can guarantee either malignancy or benignity. Additional studies such as thoracic MRI may be needed for further characterizing incidental anterior mediastinal lesions, especially for thymic cyst and for alleviating the anxiety of patients. Indeed, state-of-art thoracic MRI can offer an excellent contrast resolution which enables to depict various tissue characteristics of anterior mediastinal lesion along without motion artifact. In conclusion, the prevalence of incidental anterior mediastinal lesion ranges from 0.45–0.89% and a considerable portion of the lesions were suspected to be benign. A conservative patient-tailored approach with follow-up is required and thoracic MRI can be used as a supplementary noninvasive imaging modality.

Left ventricular noncompaction in patients with coronary artery disease: Preliminary analysis of echocardiographic findings

We retrospectively analyzed the echocardiographic findings of eight patients with left ventricular noncompaction (LVNC) and concurrent coronary artery disease. This study was conducted in Yijishan Hospital between January 2012 and May 2017. Of the eight patients, six were diagnosed with coronary arterial atherosclerosis, one patient with coronary pulmonary fistula, and one with coronary myocardial bridge. Regional wall motion abnormalities were detected in all patients. Echocardiography can provide significant information about LVNC in patients with coronary artery disease. However, whether regional wall motion abnormalities are caused by coronary artery disease or noncompaction of the myocardium remains unknown in most patients.

A case of ruptured aneurysm of coronary-pulmonary artery fistula diagnosed after emergency thoracotomy

BackgroundCoronary fistulae are occasionally detected using echocardiography or coronary angiography. We report a patient with cardiac tamponade because of a ruptured aneurysm of a coronary artery fistula.Case presentationA 60-year-old man was referred to our hospital with sudden onset of chest pain and unconsciousness. He was initially diagnosed with cardiac tamponade for type A acute aortic dissection, and an emergency operation was performed. A large amount of bleeding was seen in the pericardium, but aortic dissection around the arch was not observed. Instead, a ruptured aneurysm of a coronary-pulmonary fistula was identified on the pulmonary artery root. The aneurysm was resected, and the fistula was closed by ligation. The patient’s postoperative progress was good, and he was discharged on postoperative day 12 without any abnormalities on the coronary arteriogram.ConclusionsPreoperative diagnosis of the rupture of the small coronary artery aneurysm is difficult in such an emergency case, and this possibility should be considered in differential diagnosis when the CT image does not show typical aortic dissection.

An Insignificant Flow That Intrigues Echocardiographers. Echocardiographic Pattern in 15 Cases of Coronary-Pulmonary Fistula and Literature Review

An Insignificant Flow That Intrigues Echocardiographers. Echocardiographic Pattern in 15 Cases of Coronary-Pulmonary Fistula and Literature Review

A case of congenital coronary-pulmonary fistulas presenting as spontaneous mediastinal haemorrhage

Coronary artery fistulas are rare anomalous vascular connections between coronary arteries and a cardiac chamber or a central vessel, without an intervening capillary bed. Coronary-pulmonary fistulas are a distinct subset...

Symptomatic Coronary-Pulmonary Fistula Revealed with Coronary CT Angiography

Abstract Introduction: Coronary artery fistulas are usually incidental findings and rarely cause any clinical symptoms. Case presentation: In this case a coronary pulmonary fistula was revealed by coronary CT angiography and as it was considered responsible for the patients’ symptoms, its’ closure was performed during percutaneous coronary intervention. Conclusion: The noninvasive coronary CT angiography is a valuable examination in the diagnosis of coronary anomalies.

Late Diagnosed Left Coronary to the Pulmonary Artery Large Fistulae: An Interesting and Incidental Cath Lab Finding.

Coronary artery anomalies are congenital changes in their origin, course, and/or structure. Most of them are discovered as incidental findings during coronary angiographic studies or at autopsies. A coronary artery fistulae involve a communication between a coronary artery and a chamber of the heart or any segment of the systemic or pulmonary circulation. We present herein the case of a 67-year-old man with a recent history of exertional angina and dyspnea to usual daily activities whose coronary angiogram revealed an interesting and incidental coronary-pulmonary artery large fistulae.

Fountains in the heart-biventricular coronary cameral fistulae and bilateral coronary artery to pulmonary artery fistulae

We describe about an elderly male presented to us with effort intolerance. He was diagnosed to have multiple coronary cameral fistulae and coronary pulmonary fistulae that gives an appearance of “Fountains In The Heart”. Such a combined existence of biventricular coronary cameral fistulae and bilateral coronary artery to pulmonary artery fistulae is an unforeseen entity that has never been described before in an individual.

Unilateral and multilateral congenital coronary-pulmonary fistulas in adults: clinical presentation, diagnostic modalities, and management with a brief review of the literature.

Congenital coronary-pulmonary fistulas (CPFs) are commonly unilateral, but bilateral and multilateral fistulas may occur. In multilateral CPFs, the value of a multidetector computed tomography (MDCT) imaging technique as an adjuvant to coronary angiography (CAG) is eminent. The purpose of this study was to describe the clinical presentation, diagnostic modalities, and management of coincidentally detected congenital CPFs. Unilateral and multilateral coronary-pulmonary fistulas are increasingly detected due to the wide speard application of multidetector computed tomography which might be a supplementary or replacing to conventional coronary angiography. We evaluated 14 adult patients with congenital coronary artery fistulas (CAFs) who were identified from several Dutch cardiology departments. Fourteen adult patients (5 female and 9 male), with a mean age of 57.5 years (range, 24-80 years) had the following abnormal findings: audible systolic cardiac murmur (n = 4), chronic atrial fibrillation (n = 2), nonsustained ventricular tachycardia (n = 1), and cardiomegaly on chest x-ray (n = 2). Echocardiography revealed normal findings with trivial valvular abnormalities (n = 9), depressed left ventricle systolic function (n = 3), and severe mitral regurgitation and atrial dilatation (n = 2). The findings in the rest of the patients were unremarkable. CAG and MDCT were used as a diagnostic imaging techniques either alone (CAG, n = 6; MDCT, n = 1) or in combination (n = 7). Single modality and multimodality diagnostic methods revealed 22 fistulas including CPFs (n = 15), coronary cameral fistulas terminating into the right (n = 2) and the left atrium (n = 1), and systemic-pulmonary fistulas (n = 4). Of all of the fistulas, 10 were unilateral, 6 were bilateral, and 6 was hexalateral. (13) N-ammonia positron emission tomography-computed tomography was performed in 3 patients revealing decreased myocardial perfusion reserve. CAG remains the gold standard for detection of CPFs. An adjuvant technique using MDCT provides full anatomical details of the fistulas.

Coronary Pulmonary Fistula: A Rare Case Presenting with Recurrent Chest Pain

Background: Coronary pulmonary fistula is a rare clinical entity. Majority of them are clinically silent. But rarely chest pain, myocardial ischaemia and heart failure may be the presenting features. Coronary artery fistulas originate predominantly from the right coronary artery and are not associated with hemodynamic abnormalities or other congenital heart diseases. Case Presentation: Here we present a case of 41 years male presenting with recurrent chest pain for the last 2 years which had increased in frequency for last couple of days. Repeated Chest x rays, electrocardiograms and echocardiography being normal. Lastly this case was diagnosed by CT coronary angiography which revealed normal caliber left and right coronary arteries but abnormal torturous plexus of vessels seen to arise from proximal part of left anterior descending artery finally communicating with pulmonary trunk suggestive of coronary pulmonary fistula. Learning objective: Above case depicts an anomaly of coronary artery underdiagnosed since long time in many clinical scenarios in which patient might have repeated episodes of angina and this should be kept mind as a possible differential and CT angiography proves to be diagnostic in identifying the anomalous vessel with its origin and communications.

Giant coronary-pulmonary fistula with pulmonary atresia, ventricular septal defect, and coronary anomaly: A case report and review of literature

Congenital coronary-pulmonary artery fistula is a rare condition and is usually associated with pulmonary atresia. We present a 10-year-old girl with circumflex coronary artery to pulmonary artery (PA) fistula with a giant dilated circumflex coronary artery, ventricular septal defect (VSD), pulmonary atresia, and anomalous originofleft anterior descending (LAD) artery from right coronary sinus. The patient underwent surgical correction. We report the investigation, treatment, and review of literatureof this rare congenital anomaly associated with dilated circumflex coronary artery.

Double congenital fistulae with aneurysm diagnosed by combining imaging modalities.

Congenital coronary pulmonary artery fistula (CAF) is rare, and systemic-to-pulmonary artery fistula (SPAF) is even more so. Furthermore, congenital coronary pulmonary fistula associated with congenital SPAF is extremely rare. As far as we know, CAF and SPAF connected with an aneurysm have not been described very often. We described an 83-year-old woman with an aneurysm originating from a CAF connected to an aortopulmonary artery fistula. Chest radiography revealed a shadow at the left edge of the heart line. Multi-detector-row computed tomography (MDCT) with contrast enhancement and coronary cine angiography revealed that the shadow was an aneurysm connected to a tortuous fistula at the left anterior descending coronary artery. The aneurysm was formed by congenital coronary pulmonary and aortopulmonary artery fistulae. Echocardiography revealed predominantly systolic blood flow in the fistula from the left anterior descending coronary artery (LAD). Although neither MDCT, echocardiography nor coronary angiography alone could provide a comprehensive image of the anomaly, including the hemodynamics in the fistulae and their relationship with surrounding organs and tissues, their combination could provided important facts the led to a deeper understanding of this very uncommon occurrence.