Left Coronary Artery Fistula Research Articles

Transcatheter Closure of a Huge Congenital Coronary-Cameral Fistula With Amplatzer Occluder

Congenital coronary-cameral fistula is an abnormal connection between coronary arteries and a cardiac chamber. Although trans-catheter closure appears to be a safe alternative to surgical treatment but there is an imprecision about modality of choice. We describe a huge left coronary artery fistula to the right ventricle, found in an 8-year-old girl with dyspnea on exertion and chest pain. She was treated with an Amplatzer duct occluder. After procedure, echocardiography revealed, complete closure of fistula orifice and the girl remained completely asymptomatic during 48 months follow-up period. This study demonstrated that Amplatzer duct occluder might be a useful and safe armamentarium for coronary-cameral fistula treatment. Nevertheless, further experience and long-term follow-up studies are required to guarantee our results.

Outcomes of Transcatheter Closure of Congenital Left Circumflex Coronary Artery Fistula.

Congenital left circumflex coronary artery fistula (LCX-CAF) is a relatively rare type of coronary artery fistula (CAF); little is known about the outcomes of transcatheter closure (TCC) of LCX-CAF. All consecutive patients admitted to Fuwai Hospital and scheduled for TCC of LCX-CAF between January 2012 and December 2022 were reviewed retrospectively. Of the 25 consecutive patients (mean [±SD] age 34±20 years; 48% male) admitted and scheduled for TCC of congenital LCX-CAF, the procedure was feasible in 22 (77.3%). The mean (±SD) diameter of the fistulas was 6.99±2.04 mm; 21 (84%) patients had a large fistula (i.e., diameter >2-fold greater than non-feeding coronary artery). Occluders were deployed via a transarterial approach and arteriovenous loop in 6 (27.3%) and 16 (72.7%) patients, respectively. No procedural complications were recorded. Although the procedural success rates are similar for single LCX-CAF and left anterior descending CAF (81.25% vs. 92.86%; P=0.602), the mean time from initial angiography to first occluder deployment is significantly longer for LCX-CAF (83.06±36.07 vs. 36.00±9.49 min; P<0.001). The mean (±SD) follow-up time was 62.2±45.5 months. The incidence of myocardial infarction and recanalization of the fistula was 4.5% (1/22) and 9.1% (2/22), respectively. TCC of LCX-CAF is a feasible and effective alternative to surgical repair, with comparable outcomes in selected patients. Optimal medical therapy to prevent post-closure myocardial infarction requires further investigation.

Clinical analysis of sixty-nine children with anomalous aortic origin of the coronary artery

We aimed to analyse the clinical characteristics of children with different types of anomalous aortic origin of the coronary artery (AAOCA) at different ages, and to discuss the factors related to myocardial ischaemia. In this retrospective study, we included 69 children diagnosed with AAOCA using CT coronary angiography; we classified the participants based on the type of AAOCA, age, and high-risk anatomy. The clinical characteristics of the different AAOCA types and age groups were compared, and the correlation between manifestations and high-risk anatomy was analysed. Anomalous origin of the left coronary artery from the right coronary artery sinus, anomalous origin of the right coronary artery from the left coronary artery sinus, and a coronary artery origin without coronary sinuses was found in 10 (14.5%), 57 (82.6%), 2 (2.9%) patients, respectively. There were no significant differences in sex, clinical manifestations, percentage of positive myocardial injury markers, electrocardiogram, transthoracic echocardiography, or proportion of high-risk anatomy among the groups with different AAOCA types. According to age group, the proportion of asymptomatic infants and pre-schoolers was the highest (p < 0.001). Forty-three patients (62.3%) had high-risk anatomy and were more likely to present with severe symptoms and cardiac syncope (p < 0.05). Conclusion: There were no significant differences in the proportions of high-risk anatomy and clinical characteristics among children with different AAOCA types. We found a relation between the severity of AAOCA clinical symptoms and anatomical risk.What is Known:• Clinical symptoms in children with AAOCA are varied and the results of routine cardiological examinations lack specificity.• High-risk anatomical features, exercise, cardiac symptoms, and ALCA are risk factors for the occurrence of SCD in patients with AAOCA.What is New:• Compared the clinical characteristics of different types of AAOCA and ages.• Analysed the correlation between symptoms and high-risk anatomical features.

Long-Term Follow-Up of a Nonprogressive Left Main Coronary Artery Fistula to Right Atrium

Coronary artery fistula is a rare cardiac abnormality, occurring more frequently in young patients and treated with cardiac surgery or percutaneous interventions in most cases. We present the case of a 63-year-old man with an incidental diagnosis of coronary artery fistula, treated with conservative strategy. (Level of Difficulty: Intermediate.)

PULMONARY AND CORONARIES OF THE HEART SHOULD STAY APART: A CASE OF MULTIPLE CORONARY TO PULMONARY ARTERY FISTULAS

PULMONARY AND CORONARIES OF THE HEART SHOULD STAY APART: A CASE OF MULTIPLE CORONARY TO PULMONARY ARTERY FISTULAS

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.

Left Anterior Descendent Coronary Artery Fistula to Main Pulmonary Artery with Triple Vessel Disease:A Report of Two Cases

Coronary artery fistula is a rare anomaly of coronary artery. It represents connection between one or more ofcoronary arteries and cardiac chamber or great vessel. It can also cause significant hemodynamic changes. Toreport cases of left anterior descending coronary artery (LAD) fistula to main pulmonary artery (MPA) withconcomitant triple vessel disease.Case 1 was 59-year old male presented with intermittent chest discomfortfor a year. Echocardiogram showed severe MR with cleft at A1 and A2 and coronary angiogram resultshowed LAD fistulation to MPA. Case 2 was 57-year old male presented with chest discomfort and at the leftshoulder. Echocardiogram showed trivial MR and coronary angiogram showed triple vessel disease alongwith tortuous fistulation of LAD to MPA. Both patients underwent teflonpledget-reinforced direct suturingof fistula origin and 3-grafts coronary artery bypass graft. Patient no 1 also underwent mitral annuloplastyand valvuloplasty.Post-operative period was uneventful and both patients were discharged after 17 days and5 days respectively. Short term follow-up showed improvement of symptoms and no residual fistulation.Inshort term follow-up teflonpledget-reinforced direct suturing of coronary fistula origin result satisfactory.Larger study and further follow up is necessary.

Transient numerical simulation of the right coronary artery originating from the left sinus and the effect of its acute take-off angle on hemodynamics.

An anomalous origin of the right coronary artery from the left coronary artery sinus is usually characterized by an acute take-off angle. Most affected patients have no clinical symptoms; however, some patients have decreased blood flow into the right coronary artery during exercise, which can lead to symptoms such as myocardial ischemia. Most researchers who have studied an anomalous origin of the right coronary artery from the left coronary artery sinus have done so through clinical cases. In this study, we used numerical simulation to evaluate the hemodynamics of this condition and the effect of an acute take-off angle on hemodynamic parameters. We expect that the results of this study will help in further understanding the clinical symptoms of this anomaly and the hemodynamic impact of an acute take-off angle. Three-dimensional models were reconstructed based on the computed tomography images from 16 patients with a normal right coronary artery and 26 patients with an anomalous origin of the right coronary artery from the left coronary artery sinus. A numerical simulation of a two-way fluid-structure interaction was executed with ANSYS Workbench software. The blood was assumed to be an incompressible Newtonian fluid, and the vessel was assumed to be an isotropic, linear elastic material. Hemodynamic parameters and the effect of an acute take-off angle were statistically analyzed. During the systolic period, the wall pressure in the right coronary artery was significantly reduced in patients with an anomalous origin of the right coronary artery (t =1.32 s, P=0.0001; t =1.34-1.46 s, P<0.0001). The wall shear stress in the abnormal group was higher at the beginning of the systolic period (t =1.24 s, P=0.0473; t =1.26 s, P=0.0193; t =1.28 s, P=0.0441). The acute take-off angle was smaller in patients with clinical symptoms (27.81°±4.406°) than in patients without clinical symptoms (31.86°±2.789°; P=0.017). In the symptomatic group, pressure was negatively correlated with the acute take-off angle (P=0.0185-0.0341, r=-0.459 to -0.4167). This study shows that an anomalous origin of the right coronary artery from the left coronary artery sinus causes changes in hemodynamic parameters, and that an acute take-off angle in patients with this anomaly is associated with terminal ischemia of the right coronary artery.

The opening of left coronary artery fistula to pulmonary artery with the jet

The opening of left coronary artery fistula to pulmonary artery with the jet

Influence of malformation of right coronary artery originating from the left sinus in hemodynamic environment

BackgroundThe anomalous origin of the right coronary artery (RCA) from the left coronary artery sinus (AORL) is one of the abnormal origins of the coronary arteries. Most of these issues rarely have any effects on human health, but some individuals may exhibit symptoms, such as myocardial ischemia or even sudden death. Recently, researchers have investigated the AORL through clinical cases, but studies based on computational fluid dynamics (CFD) have rarely been reported. In this study, the hemodynamic changes between the normal origin of the RCA and the AORL are compared based on numerical simulation results.MethodsRealistic three-dimensional (3D) models of the 16 normal right coronary arteries and 26 abnormal origins of the RCAs were constructed, respectively. The blood flow was numerically simulated using the ANSYS software. This study used a one-way fluid–solid coupling finite element model, wherein the blood is assumed to be an incompressible Newtonian fluid, and the vessel is assumed to be made of an isotropic linear elastic material.ResultsThe cross-sectional area differences between the inlet of the normal group and that of the abnormal group were significant (P < 0.0001). Moreover, there were significant differences in the volumetric flow (P = 0.0001) and pressure (P = 0.0002). Positive correlation exists for the ratio of the cross-sectional area of the RCA to the inlet area of the ascending aorta (AAO), and the ratio of the inlet volumetric flow of the RCA to the volumetric flow of the AAO, in the normal (P = 0.0001, r = 0.8178) and abnormal (P = 0.0033, r = 0.6107) groups.ConclusionThis study demonstrates that the cross-sectional area of the AORL inlet may cause ischemia symptoms. The results obtained by this study may contribute to the further understanding of the clinical symptoms of the AORL based on the hemodynamics.

LEFT MAIN CORONARY ARTERYTO CORONARY SINUS FISTULA

Coronary artery fistulas are a rare cardiac anomaly making up 0.1 to 0.2% of all congenital heart defects. Coronary artery fistulas to the coronary sinus are even more rare. We describe a case of a left main coronary artery fistula to the coronary sinus. The patient is a 66-year-old male with a

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.

Pacijent sa koronarnom bolešću i hipertenzijom

Background: Cardiovascular mortality is and will be number one cause of death in years to come. Many risk factors such as hypertension, diabetes mellitus, dyslipidemias and obesity are related with increased risk of cardiovascular diseases. Case Report: We present the case of a patient with a significant medical history of hypertension, dyslipidemia, type 2 diabetes, obesity who presented to the emergency department with atypical chest pain. Patient had uncontrolled blood pressure and high level of cholesterol. He was smoker, obese and physically inactive. He underwent a cardiac catheterization that showed a stenosis on right coronary artery originating near the anterior left coronary artery sinus and coursing between. The patient was discharged home on medical management with beta blocker therapy, ACEi , statin and antidiabetic therapy, and was instructed to restrict his physical activity and reduce body weight. Conclusion: Treatment of patients with coronary artery disease is demanding control of the blood pressure, cholesterol and blood glucose. Many Guidelines try to find optimal treatment and goals in treatment in case to improve quality of life and complications. Any way symptomatic patients with coronary artery disease have 3 treatment options: medical management, coronary angioplasty and stent deployment, or surgical correction.

Surgical management of a rare circumflex coronary artery fistula draining into the coronary sinus

Coronary artery fistula (CAF) is a rare anomalous connection between a coronary artery and a cardiac chamber or a major vessel. The majority arise from the right coronary artery and drain into the right heart structures. In this report, we present a rare case of a left circumflex coronary artery fistula draining into the coronary sinus managed successfully with surgical intervention.

Multimodality Computed Tomographic Imaging of Asymptomatic Left Coronary Artery Fistula

Multimodality Computed Tomographic Imaging of Asymptomatic Left Coronary Artery Fistula

Giant Aneurysmal Left Main Coronary Artery to Right Atrium Fistula. A Case for Surgical Approach

Coronary artery fistula (CAF) is a rare congenital anomaly that can be associated with intracardiac shunts, endocarditis, myocardial infarction, or coronary aneurysms. Recent reports have emphasized the efficacy of early closure either by percutaneous transcatheter or open surgical techniques. The purpose of this article is to review a case of 43 year-old male who presented for repair of a giant aneurysmal left main coronary artery fistula emptying into the right atrium. The giant aneurysm fistula dilatation was maximally measured to be 4.3 cm x 3.5 cm. There was clear left pulmonary vein compression and the giant size raised the question of aneurysm. With its unpredictable nature and patient’s worsening symptoms and physical activity limitation, a direct ligation of fistulous tract was performed. Surgical management was safe treatment and efficacious.

Screening for prevention of cardiovascular complications in sports: the challenge going forward

E-mail: alexander.kisko@unipo.sk The three main features requested for the ideal pre-participation screening (PPS) in sports are cost-effectiveness, high diagnostic accuracy and feasibility in large populations. Controversy exists concerning increasing an efficacy of the PPS by using echocardiography (ECHO). 500 healthy athletes (aged: 16-32, median age 21 ± 5, 446 males and 54 females [8:1], participating in sports like football, athletics, handball, cycling, basketball, gymnastics) were examined during the period from 2011-2013 in a pilot study focusing on the prevention of cardiovascular complications in sports. All of the athletes were screened according to European PPS protocol with history taking, physical examination and 12-lead ECG registration. Cardiovascular abnormalities were not detected in any case. After that conventional ECHO (M-mode and 2D modalities) the exam was performed in all of the athletes and a broad spectrum of cardiovascular abnormalities was found in 14 cases (2.8%). In 7 (1.4%) athletes it was mitral valve prolapse (hemodynamically significant in 1 case), in 3 (0.6%) — bicuspid aortic valve (significant aortic stenosis in 1 case) and in other 4 cases (0.8%) it was myocarditis, myocardial bridging, noncompaction of the left ventricle and coronary artery fistula. In 4 athletes abnormalities that were found required a temporary or permanent sports activities cessation. The postulate suggesting that inclusion of ECHO into the PPS protocol may not be cost-effective should be revised today. Currently conventional techniques like M-mode and 2D are inexpensive enough (about 6.00 Euros in Slovakia), technically simple to be performed in the field in large athletic population by pocket-size ultrasound systems, powerful enough for the efficient screening and thus hold the potential to enter a screening protocol. Well-constructed, sufficiently powered, randomized and long-term controlled studies will allow an objective evaluation of ECHO contribution to the diagnostic evaluation of life-threatening cardiovascular abnormalities in athletes. Considering such evidence, a modified PPS protocol should probably be applied to the sports cardiology practice.

Clinical application of dual-source CT in the diagnosis of ALCAPA

Objective To explore the clinical usefulness of anomalous origin of left coronary artery from the pulmonary artery (ALCAPA) by dual-source CT (DSCT) angiography. Methods A total of 10 patients (mean age 5.1±5.0 yrs, age range 0.2-15 yrs| male 5) with ALCAPA who underwent DSCT angiography and echocardiography were retrospectively included.Surgery was performed in 7 patients, and conventional cardiac angiography (CCA) in 4 patients.The subjective image quality was evaluated on a four-point scale by two radiologists.Radiation dose values were calculated. Results ALCAPA in all patients were accurately displayed with DSCT with the accuracy of 100%.The left coronary arteries originate from the inferior-left wall of the pulmonary artery in 1 patients, from left lateral wall in 3 patients, from right lateral wall in 4 patients and posterior wall in 2 patients, respectively.In all cases, the origins of the right coronary artery were normal and originated from the right sinus of Valsalva of aorta,the right coronary artery was turtuous and dilated in 5 patients.All DSCT images were diagnosable.The average subjective image quality score was 2-4 (3.2±0.8).Two radiologists made good agreement (k=0.79).The ED was (0.56±0.28) mSv.Seven cases were diagnosed correctly by echocardiography while 3 cases was misdiagnosed as dilated cardiomyopathy, left coronary artery-pulmonary artery fistula and endocardial fibroelastosis, respectively. Conclusion Low-dose DSCT angiography provides high diagnostic accuracy for the assessment of ALCAPA. Key words: Coronaryarterydisease; Tomography,X-raycomputed; Echocardiography

Surgical Management of Left Circumflex Coronary Artery Fistula: A 25-Year Single-Center Experience in 29 Patients

Left circumflex coronary artery (LCX) fistula is rare, and surgical experience is limited. We report our experience with 29 patients with LCX fistula during a 25-year period in terms of clinical features, pathology, surgical procedure, and late outcomes. Between June 1988 and July 2013, 29 patients (19 males, 10 females; median age, 10 years) with LCX fistula were treated surgically and followed up. Preoperative diagnosis was made echocardiographically in 29 patients and angiographically in 17. The fistula drained into the right atrium in 12, the right ventricle in 8, left atrium and left ventricle, each in 3, main pulmonary artery in 2, and coronary sinus in 1. Surgical procedure included endocardial closure in 17 patients, epicardial closure in 5, endocardial and epicardial closure in 2, suture ligation in 1, and off-pump suture ligation in 4. Postoperative anticoagulation was prescribed for at least 6 months. There were no operative deaths. Complications included residual shunt in 2 patients, and LCX thrombosis, pneumothorax, hemoglobinuria, and wound infection, each in 1 patient. At the latest follow-up extending to 25 years (mean, 10.1±4.6 years), 17 patients were asymptomatic and in New York Heart Association functional class I, 4 in II and 2 in III. Residual shunt, myocardial infarction, and right atrial thrombosis occurred, each in 1 patient. Surgical repair of LCX fistula is safe and effective, with low risks and favorable late outcomes. Our experience implies the necessity for postoperative anticoagulation therapy to achieve good long-term outcomes.

Left coronary artery fistula to right ventricle complicated heart failure in a patient on hemodialysis

Coronary artery fistulas (CAF) are rare, and are most often diagnosed by echocardiography or by coronary angiography. The incidence of this disease is very low, with a more frequent occurrence of fistulas originating in the right coronary artery. There is a higher incidence of CAF to right heart chambers, with CAF to the left ventricle (LV) being rare. Treatment can be surgical or percutaneous [1]. This report describes a case of CAF to the right ventricle (RV) resulting in severe pulmonary hypertension, in a patient with end-stage renal disease (ESRD) on hemodialysis and rheumatoid arthritis [2]. The patient had a history of hypertension for over 30 years [3]. Computed tomographic pulmonary angiography ruled out pulmonary embolism, but it suggested a coronary fistula to the RV cavity. A 61-year-old woman was referred for cardiac evaluation for chest pain and worsening dyspnea. The patient was on maintenance hemodialysis for the prior 2 years owing to ESRD. Clinical examination revealed tachycardia, crackles at both bases with no wheezes, rhonchi, or other adventitious sounds, a blood pressure of 160/70 mmHg. The patient had a radio-cephalic fistula constructed at the left wrist between the radial artery and the cephalic vein, using end-to-end anastomosis. An electrocardiogram showed evidence of a right bundle branch block, and signs of ventricular overload. Cross-sectional echocardiography with Doppler interrogation revealed a left ventricular ejection fraction of 55 %, and there was evidence of diastolic dysfunction, without important calcification or regurgitation of the valves.