Large Coronary Artery Fistula Research Articles

Large coronary artery fistulas: An unexpected finding during diagnosis of coronary artery disease.

Large coronary artery fistulas: An unexpected finding during diagnosis of coronary artery disease.

Percutaneous transcatheter embolization in large tortuous coronary artery fistula patient: a case report

Percutaneous transcatheter embolization in large tortuous coronary artery fistula patient: a case report

Abstract 12088: Left Ventricular Non-Compaction, Coronary Artery Fistula, and Infective Endocarditis: A Rare Combination

Description of Case: A 48-year-old man underwent echocardiography for multifocal subacute infarctions found on brain MRI. No intracardiac shunts were found, but prominent LV trabeculae raised suspicion of LV non-compaction (LVNC). LV ejection fraction was 53%, and LV volume was within upper-normal range. Cardiac MRI confirmed these findings, although non-compacted:compacted myocardium ratio was 1.9. (Panel A-B) A right coronary artery to LV fistula was also diagnosed. (Panel C-D) The patient was followed-up uneventfully, but 10 months later was admitted after a generalized seizure episode. Brain MRI detected multiple new hemorrhagic infarcts, and echocardiography revealed a 10.8mmх10.1mm mobile mass and high-speed diastolic flow near the basolateral LV wall. (Panel E-F) Gemella morbillorum was identified on two blood cultures. The patient underwent surgery for fistula closure and vegetation resection. Vegetation pathology and culture however was negative for bacterial growth. Paroxysmal atrial fibrillation was also detected, before discharge with full recovery. Discussion: LVNC and coronary artery fistula (CAF) are both caused by arrest in embryonic myocardial compaction. Despite a hypothetical common origin, reports of co-occurrence are extremely rare. This is the first to report the association of a mild form of LVNC and a single large CAF. This is also the first to report infective endocarditis due to CAF by G. morbillorum . G. morbillorum infective endocarditis is rare, subacute in course, and causes significant destruction. The extensive, prolonged embolism found here has not been reported in other cases of CAF-associated infective endocarditis and may be due to G. morbillorum .

Large cameral coronary artery fistula in a 5 months old infant with unusual presentation and fatal outcome: -case report

BackgroundCongenital coronary fistulas (CAFs) are uncommon abnormalities communicating the coronary arteries with the cardiac chambers or portion of the systemic or pulmonary circulation. Over 90% of the cases drain into the right side of the heart with only 3% terminating in the left ventricle. Infants with a large CAFs may develop congestive heart failure.Case presentationA 5 months old female infant presented with labored breathing and worsening of bluish discoloration of the lips and extremities following a prolonged cry. She had a history of breastfeeding difficulty and noticeable bluish discoloration of the lips and extremities since birth. The infant was wasted and had a fast heart rate, bluish lips, and nail beds with clubbing of fingers and toes. A cardiac murmur was noted during her medical checkup. Chest x-ray showed cardiomegaly. Echocardiography and CT angiography showed large Cameral CAF involving the left main and left anterior descending artery draining into the left ventricle. The tricuspid valve was dysplastic, there was secundum ASD, and VSD with a right to left shunt. The patient developed episode of cyanotic spells after crying excessively following a CT angiographic procedure which culminated in respiratory arrest and her demise. She was managed as a case of hypoxic spells in the ICU before her death.ConclusionThis report unveiled unfamiliar case of Cameral coronary artery fistula with left-to-left shunting, cyanosis, and dysplastic tricuspid valve.

Coronary Artery Fistulas: Indications, Techniques, Outcomes, and Complications of Transcatheter Fistula Closure.

Coronary artery fistulas (CAFs) are rare coronary anomalies that are usually diagnosed incidentally with cardiac imaging. Small CAFs are generally asymptomatic and can close over time, while some untreated medium or large CAFs can enlarge, leading to clinical sequelae such as cardiac chamber enlargement or myocardial ischemia. With the advancement of transcatheter equipment and techniques, CAFs have been increasingly closed using a percutaneous approach. However, the procedure is not free of limitations given the risk for myocardial infarction, device embolization, and fistula recanalization. In this review, the authors illustrate the contemporary procedural considerations, techniques, and outcomes of transcatheter CAF closure.

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.

Successful percutaneous occlusion of a large left circumflex coronary artery fistula draining into the coronary sinus using a ventricular septal defect occluder: a case report

BackgroundCoronary artery fistula (CAF) is a congenital anomaly of the coronaries that can lead to significant intracardiac shunting and myocardial ischaemia.Case summaryWe describe the case of a 15-year-old male with an incidentally documented precordial cardiac murmur. An evidently dilated coronary sinus (CS) on transthoracic echocardiography prompted further investigation. A computed tomography (CT) revealed the presence of a large CAF from the left circumflex coronary artery to the CS. No other structural heart defects were detected. A haemodynamically significant intracardiac shunt was confirmed during cardiac catheterization, and it was decided to close the fistula. This was successfully performed using a ventricular septal defect (VSD) occluder (Konar 10-8, Lifetech Scientific) that was deployed through a 6 Fr right coronary guiding catheter. A partial thrombotic occlusion of the CS behind the closure device was noted during follow-up which led to anticoagulation in a higher target INR range and concomitant start of low dose carbasalate calcium to reduce further retrograde thrombus extension. Patient is doing well at over 1 year of follow-up, and no further thrombotic extension into the CS was seen on a recent CT.DiscussionThis report illustrates the diagnostic workup and a percutaneous treatment strategy of a CAF using a VSD occluder. We also describe a not previously reported complication, thrombotic CS occlusion. Improving transcatheter techniques and marketing of novel devices with a broad spectrum of applications can offer new opportunities for treating CAF and avoiding surgical correction often involving cardiopulmonary bypass, reserving this option for patients with complex anatomy or failed transcatheter closure.

Transcatheter closure of coronary artery fistula: A 21-year experience.

To evaluate the outcomes of transcatheter coronary artery fistula (CAF) closure and to identify anatomic/procedural factors that may impact outcomes. Due to the rarity of CAF, reported experience with transcatheter closure remains limited and anatomic and procedural factors that may lead to unsuccessful closure, complications, or recanalization of CAF are unclear. All patients who underwent transcatheter CAF closure at Mayo Clinic from 1997 to 2018 were retrospectively reviewed. CAF anatomic characteristics, procedural techniques, and clinical/angiographic outcomes were assessed. A total of 45 patients underwent transcatheter closure of 56 CAFs. The most commonly used devices were embolization coils in 40 (71.4%) CAFs, vascular occluders in 10 (17.8%), or covered stent in 2 (3.6%). Acute procedural success with no or trivial residual flow occurred in 50 (89.3%) CAFs. Residual flow was small in three (5.4%) and large in three (5.4%). Eight (17.8%) patients had complications, including device migration in three, intracranial hemorrhage from anticoagulation in one, and myocardial infarction (MI) in four. MI was a result of covered stent thrombosis or stagnation of flow after closure of large distal CAF. Twenty-two patients with 27 CAFs had follow-up angiography after successful index procedure at median time of 423 (IQ 97-1348) days. Of these, 23 (85.2%) had no/trace flow and 4 had large flow from recanalization. Transcatheter CAF closure is associated with a favorable acute procedural success and complication rate in selected patients. Procedural success and risk for complication are highly dependent on CAF anatomy and closure technique.

A study on coronary artery anomalies in adult patients undergoing coronary angiography for various indications

Introduction: As variations in coronary artery anatomy is very common, the term “coronary artery anomaly” (CAA) applies only to the rarer forms of anatomic aberrations seen in the general population. CAAs are usually detected incidentally during coronary angiography (CAG) or autopsy. Some hemodynamically significant anomalies cause symptoms at young age and can cause sudden death. Knowledge of CAA is necessary to suspect them in appropriate clinical setting for early diagnosis and management that may be lifesaving. Subjects and Methods: Over a period of 1 year, we studied coronary anatomy of 1000 adult patients attending a tertiary cardiac center for coronary artery disease, valvular heart disease planning valve surgery, etc., where CAG was required. The absolute prevalence of different CAAs was recorded. Results: In our study, 3.6% of the patients had CAA. Most common of them were “right coronary artery arising from the left sinus” and “separate origin of the left anterior descending artery and left circumflex artery from the left sinus.” A significant coronary artery fistula was the next common. Conclusion: Some CAAs made coronary intervention technically challenging. There were hemodynamic implications in some, namely myocardial ischemia resulting from significant myocardial bridge and “coronary steal phenomenon” related to large coronary artery fistula. A high index of suspicion is required for early diagnosis, and the management of most serious forms can abort serious consequences. Information regarding CAAs is also helpful to overcome procedural difficulty during coronary and cardiothoracic interventions and avoid complications.

P1330 A rare coronary anomaly in the adult: an extremely large arteriovenous fistula

Abstract Introduction Arteriovenous coronary fistulae are a rare coronary anomaly, which can be congenital or acquired. They can be diagnosed in older adults with heart failure symptoms, atherosclerosis or cardiac arrhythmias. The authors report the case of an adult patient with an extremely large coronary artery fistula of the left main coronary artery (LMCA). Clinical case A 57-year-old caucasian male with known background of arterial hypertension, obesity, pulmonary emphysema and bronchiectasis presented to a Cardiology outpatient appointment with symptoms of congestive heart failure and new-onset atrial fibrillation. A transthoracic echocardiogram was performed which revealed a possible coronary fistula with multiple rosary-like folds between the LMCA and the coronary sinus. Other echocardiographic findings were left ventricular and biatrial enlargement with biventricular systolic dysfunction (left ventricular ejection fraction 44%) and a GLS of -7.8% as well as mild pericardial effusion. The patient was referred to our hospital for further diagnostic work-up and clarification of the coronary anatomy. A cardiac computed tomography (CT) scan was done which showed ectasia and calcification of the LMCA, left anterior descending and circumflex arteries and a large caliber tortuous coronary fistula between the LMCA, the right atrium and the coronary sinus comprised of multiple folds covering from the pulmonary artery to the left atrium. A coronary artery angiography was also performed, which confirmed the detailed anatomy and dimensions of the coronary fistula. Follow-up magnetic resonance imaging revealed dilation of both left and right cardiac chambers with no significant shunt (QP/QS = 1) The patient was started on heart failure medical therapy and was referred to the Cardiac Surgery Department and is currently asymptomatic awaiting for surgical correction of the coronary fistula. Abstract P1330 Figure. CT scan: large caliber coronary fistula

Early and late presentation of coronary artery fistula: a possible natural progression?

We present two patients, one 10 years old and another 43 years old, who both had successful transcatheter closure of left main coronary artery to right atrium fistulas. The older patient had a larger fistula as well as more symptoms and a complicated post-procedure course. Closure of medium or large coronary artery fistulas should be considered at younger ages to minimise future complications.

TCTAP C-227 Endovascular Embolization of Large and Tortuous Coronary Artery Fistula

### Patient Initials or Identifier Number Ms. C, 05482480 ### Relevant Clinical History and Physical Exam A 60-year-old female with a history of hypertension. She suffered from palpitation with chest tightness and dyspnea for 3 months. A focused physical examination discovered regular heartbeat

A snare retrieval experience of coil migration in a large coronary artery fistula

A 45-year-old female patient was referred due to the abnormal myocardial perfusion scintigraphy showing ischemia in the inferior and lateral wall. Coronary arteries were normal, and a large fistula was detected from the proximal portion of the circumflex coronary artery (Cx) draining into the pulmonary artery. Percutaneous closure of the coronary artery fistula (CAF) was considered, and a 3 mm × 50 mm-Balt coil was planned to place the proximal portion of the fistulized artery. Unfortunately, during placement of the coil, it was opened early and migrated to the proximal segment of the Cx, the left anterior descending artery, and the distal part of the left main coronary artery. A snare was moved into the extra backup guiding catheter immediately. The migrated coil was retrieved with the snare successfully. Subsequently, 4 mm × 12 mm and 2 mm × 25 mm-Balt coils were placed in the mid portion of the fistulized artery until total occlusion was obtained. A CAF is described as a direct connection between one or more of the coronary arteries and a cardiac chamber or great vessel. The fistula may cause serious hemodynamic disturbances such as myocardial ischemia, high-flow heart failure, right ventricle volume overload, endocarditis, rupture, thrombosis, embolism, and arrhythmias. Percutaneous closure is the prior technique, in the absence of complex conditions such as multiple fistulas and large fistula branches and in cases where the fistula can be simply reached. There have been very rare data which contain complications about the percutaneous closure of CAFs.

Transcatheter Embolization of a Large Coronary Artery Fistula in a Child

Coronary artery fistula is a rare congenital disease of a coronary circulation. The progress is usually favorable, but in case of a large right atrial coronary fistula a volume overload with a progressing heart failure may occur.

Combined percutaneous and surgical treatment of a large coronary artery fistula connecting the left anterior descending artery to the right ventricle in an 8-year-old child.

Combined percutaneous and surgical treatment of a large coronary artery fistula connecting the left anterior descending artery to the right ventricle in an 8-year-old child.

Transcatheter closure of coronary artery fistulas in infants and children: A French multicenter study.

The short-term efficacy and safety of transcatheter closure (TCC) for the management of coronary artery fistulas (CAFs) was investigated in pediatric patients. CAFS are rare with potentially severe complications and their management is still a matter of debate. Percutaneous closure appears to be the treatment of choice in anatomically suitable vessels but limited data are available in the pediatric population. This retrospective, observational, multicenter, national study included patients under 16 years of age who underwent TCC of a congenital CAF. Patients with additional congenital heart defect were excluded. 61 patients (36 girls, 25 boys) with a median age of 0.6 year [0-15.4] at diagnosis and 3.9 years [0-16] at procedure were included. The CAF was large in 48 patients (79%); it was distal in 23 (38%) and proximal in 22 (36%). Most patients (77%) were asymptomatic at diagnosis. Clinical signs of congestive heart failure were present in seven patients (11%). Perioperative complications included three cases of ST elevation myocardial infarction (exclusively during attempted closure of a distal CAF), three devices migrations, and one case of leg ischemia. One patient died after surgical closure of a large distal CAF that could not be closed by TCC. Follow-up data were collected for 43 patients (70%) for a median of 91 days [0-4,824]. The Kaplan-Meyer estimate for complete occlusion at 2 years was 73 ± 7.6%. TCC in the pediatric population appears to be effective and associated with few complications.

Surgical Ligation of Bilateral Large Coronary Artery Fistula to Pulmonary Artery

A 63-year-old woman was admitted to our hospital due to a grade III systolic murmur over the pulmonary area. A chest x-ray ([Figure 1A][1]) showed cardiomegaly with abnormal vascular shadow over the left atrium area. Transthoracic echocardiography showed coronary artery drainage into pulmonary

Large coronary artery fistula

Summary We present a case of congestive heart failure with pulmonary artery hypertension caused by a left-to-right shunt. Physical examination on admission revealed hypertension, arrhythmia, a diastolic murmur over the bilateral sternal borders, and a pitting edema over both lower legs. Imaging studies revealed a large coronary artery fistula (CAF). After ligation of the fistula, the patient recovered adequately and was discharged. Although cases of CAF have been reported and clinical presentations such as congestive heart failure are not rare, CAFs require particular attention, because they typically exhibit a varied clinical course. We present this case to share our experience regarding myocardial protection and help practitioners prevent misdiagnosis or delayed treatment for such cases.

Transcatheter closure of medium and large congenital coronary artery fistula using wire-maintaining technique

BackgroundFor medium and large coronary artery fistula (CAF), the initially selected device sometimes has to be exchanged by reconstruction of track wire loop due to the complexity of CAF. ObjectivesWe sought to evaluate the feasibility and safety of transcatheter closure of medium and large CAF by using the wire-maintaining technique (WMT). MethodsA total of 18 patients aged 15–56 years with congenital CAF underwent percutaneous transcatheter closure by WMT between April 2006 and October 2012. The immediate and long-term outcomes were evaluated. ResultsOf the 18 patients (11 females), 16 (88%) underwent successful transcatheter closure of fistula using WMT. The CAFs originated from the right coronary artery (67%), the left circumflex coronary artery (28%), and the left anterior descending coronary artery (5%). The drainage sites were the right ventricle (56%), right atrium (22%), left ventricle (11%), and coronary sinus (11%). The mean diameter of fistulas was 9.5±1.71mm and mean size of the devices was 13.6±3.03mm. An angiogram following device deployment showed complete occlusion in 11 patients, mild residual shunt in 2 patients, and trivial residual shunt in 3 patients. One patient had transient ST–T wave changes, and one patient had hemolysis after the procedure. Follow-up ranged from 1 month to 54 months (median 39 months). Echocardiogram showed trivial residual shunt in 3 patients at 6-month follow-up and in 1 patient at 12-month follow-up. Coronary artery thrombosis was observed in 1 patient by multislice computed tomography at 12-month follow-up. ConclusionFor those patients with medium and large complex fistula, transcatheter closure of CAF can be performed by using the wire-maintaining technique.

Surgical Management of Coronary Arteriovenous Fistula in Patients Presenting with Acute Coronary Syndrome—A Local University Hospital 6 Years Experience

Background: Anomalies of the coronary arteries are uncommon, usually discovered incidentally during diagnostic cardiac catheterization or cardiac computed tomography (CCT). Coronary artery fistula (CAF) is one of the varieties of coronary termination anomalies. Some of CAF patients have symptoms of myocardial ischemia. Methods: In King Abdulaziz university hospital (KAUH) over six years period, five patients presented with acute coronary syndrome (ACS) and were diagnosed to have CAF by cardiac catheterization during the diagnostic workup of ischemic heart disease (IHD), four males and one female, mean age 57.4 ± 6.6 years; four patients had CAF with associated coronary atherosclerotic disease (CAD); one patient had large complex CAF with no significant CAD; all patients with CAD underwent closure/excision of the CAF with surgical revascularization; the patient with no CAD preferred surgical excision over endovascular intervention. Results: All patients had surgery with uneventful postoperative course and they were doing well with 3 to 7 years outpatient follow up. Conclusion: Surgical management is safe in patients with coronary artery anomalies presenting with ACS.