Coronary-pulmonary Fistula Research Articles

Coronary fistula between the left anterior descending coronary artery and the pulmonary artery: Two case reports

Coronary artery fistulae are rare congenital or acquired connections between the coronary vessels and the cardiac chambers or other vascular structures. We present two consecutive cases of coronary fistulae between the proximal left anterior descending artery (LAD) and the main pulmonary artery. Both cases where admitted with history of acute coronary syndromes and had multivessel coronary disease along with coronary pulmonary fistulae. The two cases were managed by coronary artery bypass grafting (CABG) and repair of the fistulae.

Coronary-Pulmonary Fistulas Involving All Three Major Coronary Arteries Co-Existing With Myocardial Infarction

We report the case of a man who presented with acute anterior myocardial infarction and in whom the coronary angiogram showed tight stenosis of the left anterior descending coronary artery and the right coronary artery associated with substantial coronary-pulmonary fistulas involving all three major coronary arteries. We discuss the possible links between coronary artery fistulas and myocardial infarction.

Bilateral coronary-pulmonary fistulae, diagnosed by transoesophageal echocardiogram

Bilateral coronary artery fistulae to pulmonary artery is a rare condition. We diagnosed this condition by transoesophageal echocardiogram and successfully treated with surgery.

Noninvasive Demonstration of Dual Coronary Artery Fistulas to Main Pulmonary Artery with 64-Slice Multidetector-Computed Tomography: A Case Report

Coronary artery fistulas, including coronary pulmonary fistulas, are usually discovered accidently among the adult population when undergoing invasive coronary angiographies. We report here a 58-year-old woman with dual fistulas originating from the left anterior descending coronary artery and right coronary sinus to the main pulmonary artery, demonstrating noninvasively with multidetector-computed tomography (MDCT) and transthoracic echocardiography (TTE).

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.

Demonstration of coronary-to-pulmonary fistula with MDCT and conventional angiography

The coronary pulmonary fistulas are usually discovered incidentally during routine cardiac catheterization after the development of atherosclerotic coronary artery disease. Here we present a 59-year-old man with anginal symptoms who was found to have two fistulas originating from the left coronary system and right coronary sinus and draining into the pulmonary trunk. We delineated the courses of the fistulas in detail using both of the imaging techniques of MDCT and conventional angiograhy.

Padronização da técnica para cirurgia cardíaca videoassistida: experiência inicial

Minimally invasive cardiac surgery has been performed in major worldwide centers, including procedure such as valves, coronary and congenital surgery. To demonstrate our first works with noninvasive cardiac surgery by mean of the experience gained with general and thoracic surgery. Whenever possible to carry out a minimally invasive cardiac surgery, this was the approach of choice. The left thoracoscopy was used in four cases: (1) symptomatic coronary-pulmonary fistula ligation; (2) implant of an epicardial electrode into the left ventricle for resynchronization; (3) excision of pericardial giant lipoma in the left atrium, and (4) resection of hemangiolipoma in the mediastinum. Right thoracoscopy with extracorporeal circulation through cardiopulmonary bypass via femoral vein and artery and cardiac arrest in ventricular fibrillation with moderate hypothermia were carried out in the following cases: (5) patient with mitral stenosis after surgical repair with Carpentier ring 12 years before. An anterior and posterior commissurotomy without thoracotomy was successfully made; (6) patient with idiopathic dilated cardiomyopathy, high-response atrial fibrillation, and severe mitral insufficiency, underwent mitral repair surgery with Gregori's ring and ablation of the pulmonary veins with radio-frequency catheter. (MAZZE modified). No death occurred in this series and the surgical result in all cases was highly satisfactory. All patients were discharged from hospital with a mean time of 5.5 +/- 5 days after intervention. Our initial experience in this field proves the effectiveness and the viability in introducing this type of technique.

Coronary Artery Fistulas in Pulmonary Atresia and Ventricular Septal Defect

Pulmonary atresia with ventricular septal defect is an anomaly with highly variable anatomy. Rarely, a coronary artery-to-pulmonary artery fistula may contribute to pulmonary blood flow. Since 1996, we have treated 4 patients with coronary-pulmonary fistula associated with pulmonary atresia and ventricular septal defect. Two fistulas originated from the left coronary, one from the right coronary, and one from a right-sided solitary coronary system. All terminated in the main pulmonary artery, which was adequate in all cases. The fistulas were managed by direct internal closure. Total intracardiac repair was then accomplished in all patients at the same sitting. There was one death. In children with favorable anatomy, direct closure of the fistula from the pulmonary artery is adequate and allows single-stage intracardiac repair.

Coronary-pulmonary fistula serving as a collateral source to the occluded coronary artery in a patient with myocardial infarction

1. Case report A 71-year-old man was admitted to the hospital because of atypical chest pain. He had a history of anterior wall myocardial infarction 15 years ago. He had not undergone any surgical treatment. Electrocardiogram revealed QS pattern on left precordial leads. Exercise myocardial perfusion scintigraphy using thallium-201 showed fixed defect in the anterior wall, intraventricular septum and apex without additional ischemia on exercise. Coronary angiography showed the total occlusion of the proximal of left anterior descending artery (Fig. 1). Collateral circulation to the distal portion of the left anterior descending artery was supplied from the conus branch of the right coronary artery by way of the coronary-pulmonary fistula (Fig. 2A). The Rentrope grade of collateral circulation was 3. The drainage from the conus branch to the pulmonary artery was also demonstrated (Fig. 2B). Lung perfusion scintigraphy with technetium-99m macroaggregated albumin was performed to evaluate the shunt flow from the coronary artery to the pulmonary artery, but it revealed no defect in the lung. Since the patient had no sign of ischemia due to the coronary artery steal phenomenon or to additional myocardial ischemia in the territory of the left anterior descending artery on exercise, and no sign of disturbed pulmonary blood flow, surgical treatment was not performed. 2. Discussion

Dilated Cardiomyopathy Caused by a Coronary - Pulmonary Fistula Treated Successfully With Coil Embolization

We describe a case of dilated cardiomyopathy (DCM) caused by a coronary-pulmonary fistula and myocardial ischemia induced by the coronary steal phenomenon, which was successfully treated with coil embolization. Coronary fistulae and coronary-steal-induced ischemia are rare causes of DCM in adults with normal coronary arteries. Percutaneous treatment represents an alternative to surgery and may be offered as a relatively low-risk procedure. The choice between surgical and percutaneous treatment must take into account clinical and anatomical considerations.

Successful repair of coronary artery–pulmonary artery fistula with coronary artery disease and atrial septal defect in an adult

Coronary artery fistula is a very uncommon vascular communication between coronary arteries and other cardiac structures (chambers or great vessels). However, there have been several reports since 1865 with different variations in anatomy, level of communication, and clinical course. We report an adult case of coronary arteriovenous fistula arising from the left anterior descending artery (LAD) and draining anomalously into the main pulmonary artery (PA) combined with coronary artery disease (CAD) and atrial septal defect (ASD).

Pulmonary atresia, ventricular septal defect, and coronary-pulmonary artery fistula

We report 2 patients with pulmonary atresia, ventricular septal defect, and coronary-pulmonary fistula. The fistula originated from the left anterior descending artery in 1 patient, and from the right coronary artery in the other. Both patients survived staged correction in which right ventricular outflow was reconstructed with autologous fistula tissue. One patient with pulmonary hypertension suddenly died 9 months after surgery. Twenty-four patients with pulmonary atresia, ventricular septal defect, and coronary-pulmonary fistula have been reported previously.

Estimation of shunt flow in coronary-pulmonary fistula by lung perfusion scintigraphy with technetium-99m macroaggregated albumin

The shunt flow from the coronary artery to pulmonary arteries was evaluated in 6 patients with coronary-pulmonary fistula by lung perfusion scintigraphy with technetium-99m macroaggregated albumin. In 2 patients, whose degree of visualization of pulmonary arteries by coronary angiography was relatively high, lung perfusion scintigrams demonstrated the defects at the distal of coronary-pulmonary fistulas.

Multiple coronary-pulmonary fistulae involving all three coronary arteries: a case report

Coronary pulmonary fistulae are rare cardiac anomalies. We present the case of a 46-year-old woman with multiple coronary-pulmonary fistulae involving all three coronary arteries. She presented with atypical chest pain and had no obstructive coronary lesion. SPECT thallium study demonstrated no perfusion defect. The fistulae were multiple but small with only a small left to right shunt (Q p:Q s = 1.2). The patient has remained well without intervention.

Stress MIBI scintigraphy in multiple coronary-pulmonary fistula: failure to demonstrate “steal” phenomenon

Stress radionuclide studies were performed in a patient with angiographically proven multiple coronary-pulmonary fistulas, in the presence of atypical chest pain. MIBI scintigraphy showed no myocardial perfusion defects. Multigated ventriculography showed an ejection fraction of 68% and 80% at rest and following exercise, respectively. Three separate fistulas were present between each coronary artery and the pulmonary trunk. The Qp:Qs ratio was 1.3. In the presence of atypical chest pain, stress MIBI scintigraphy and multigated ventriculography both failed to reveal myocardial ischemia in a 49-year-old patient with multiple coronary-pulmonary fistulas. She is using no medication, but advice concerning endocarditis prophylaxis was given.

Coronary-pulmonary fistula: long-term follow-up in operated and non-operated patients

Eleven cases with 13, incidentally found coronary-pulmonary fistulous communications were discovered out of about 11 000 diagnostic coronary angiograms performed in different patients, over the period 1968 to 1989. These patients were followed-up for an average period of 4.4 years (range 2–11 years). The majority had a fistulous malformation originating from the proximal part of the left anterior descending artery and terminating in the pulmonary trunk. In three subjects, the right coronary artery participated in formation of the shunt. The fistulas consisted either of a convoluted mass of serpentive vessels, sometimes with aneurysmal formation, or of a solitary single vessel. Angina pectoris, atypical chest pain and fatigue were the most common symptoms. All patients were treated conservatively except one, who underwent ligation of the fistula and coronary arterial bypass grafting. Two subjects are still free of symptoms. No death occurred. None of the patients developed subacute bacterial endocarditis, acute myocardial infarction or left ventricular failure during the period of follow-up of more than four years. Three individuals, prior to the follow-up period, had suffered myocardial infarction contralateral to the shunt. The had no recurrence.

Doppler echocardiographic findings in coronary-pulmonary fistula

We describe a patient with a coronary-pulmonary fistula who had a syncopal attack. He had also pectus excavatum. Doppler echocardiography revealed late diastolic flow in the left high parasternal region which was not caused by pulmonary insufficiency, but by the jet through the fistulous communication. Selective coronary angiography demonstrated the fistula between the left anterior descending artery and the pulmonary trunk.

Anomalous Communication of the Left Coronary Artery with a Peripheral Branch of the Right Pulmonary Artery

A 64-year old man had a history of two myocardial infarctions recurrent episodes of paroxysmal ventricular tachycardia and hemoptysis. Cineangiocardiographic studies showed an anomalous vessel connecting the left coronary artery with a peripheral branch of the right pulmonary artery. Although several coronary obstructive lesions and abnormalities in the distribution of the circumflex branches were found, the anomaly apparently produced a real "pulmonary steal" and, thereby a worsening of the coronary insufficiency. We believe that this is the first reported case in the literature with such a coronary-pulmonary fistula. The angiographic findings are presented in detail, and the possible factors in the development of myocardial ischemia are discussed.