Pulmonary Artery Fistula Research Articles

Direct Puncture and Embolization of a Congenital Bronchial Artery to a Pulmonary Artery Fistula

A 55-year-old woman with an incidentally detected bronchial artery-to-pulmonary artery fistula (BPF) with dilation of 33-mm maximum diameter (Fig 1) underwent prophylactic embolization to avoid potential rupture and catastrophic hemorrhage. Three systemic arteries, the right bronchial, right superior thyroid (Fig 2), and aberrant right subclavian arteries, converged into a sac-like component of 16-mm diameter at the superior mediastinum. The sac proceeded as a single dilated outflow vessel meandering downward in the anterior mediastinum, narrowing and draining into the proximal part of the pulmonary artery.

Complex coronary pulmonary artery fistulae with a large aneurysm: a rare anomaly treated with surgery.

Complex coronary pulmonary artery fistulae with a large aneurysm: a rare anomaly treated with surgery.

A Fistula Where? Left Anterior Descending to Pulmonary Artery Fistula

Fistulas are abnormal passageways between two organs or vessels that usually do not connect. Coronary artery fistulas occur when one of the coronary arteries is connected to either a heart chamber or another blood vessel. This case presents a coronary artery fistula which may or may not be impacting the patient’s heart function. A 69-year-old male with multiple comorbidities presents with a chief complaint of shortness of breath. Catheterization reveals an anomalous left anterior descending to pulmonary artery fistula without a step up in oxygen saturation at the level of the pulmonary artery. Surgical management was deferred as this fistula was not deemed to contribute to the patient’s declining cardiac function. Operative management versus embolization would be a feasible alternative for patients who are symptomatic secondary to the coronary artery fistula and remains to be controversial in patients who are asymptomatic. Given the possibility of these fistulae eventually causing symptoms it would be practical to close them early on before symptoms arise or before size of the fistulae becomes an issue. Further research should be conducted to understand the management strategies for patients who present with coronary artery fistulas. J Med Cases. 2020;11(10):306-308 doi: https://doi.org/10.14740/jmc3527

THE ABNORMAL DIASTOLIC FLOW IN THE PULMONARY ARTERY DOPPLER ON TRANSTHORACIC ECHOCARDIOGRAPHY (TTE)

Coronary Artery Fistulae (CAF) account for approximately 0.31% of all congenital heart defects, the most common being coronary to pulmonary artery (CP) fistula. Most CAF are incidentally found on coronary angiography with the prevalence of 0.9%. A 36 year gentleman presented with recurrent episodes

SUCCESSFUL DIFFERENTIATION OF CORONARY PULMONARY ARTERIAL FISTULA FROM MEDIASTINAL TUMOR BY ECG-GATED COMPUTED TOMOGRAPHY

Coronary pulmonary arterial fistula (CPAF) may cause enlargement of an aneurysm, which may rupture or compress other organs, and may be difficult to differentiate from a mediastinal tumor. A 81-year-old female was diagnosed with a mediastinal tumor on non-ECG-gated CT. Tumor size gradually

P1727 Large coronary artery to pulmonary artery fistula as primary source of pulmonary blood supply in tetralogy of fallot with pulmonary atresia

Abstract Funding Acknowledgements Not Applicable OnBehalf Not Applicable Introduction Pulmonary blood supply in patients of Tetralogy of Fallot with pulmonary atresia is usually from patent arterial duct or major aortopulmonary collaterals (MAPCAs) arising from descending thoracic aorta. We describe a case in which large coronary to pulmonary artery fistula was the primary source of pulmonary blood supply. Case Report A 17 years old female was referred to our hospital for diagnostic workup of suspected congenital heart disease. She was previously undiagnosed and now complains of progressive shortness of breath for last few months. On physical examination she was non-dysmorphic with oxygen saturation of ∼ 77 % in room air, blood pressure of ∼ 117/72 mmHg, pulse rate of ∼ 89 beats per minute and respiratory rate of ∼ 24 breaths per minute. She was clinically cyanosed with grade 3 clubbing and polycythemic. Cardiovascular examination revealed quiet precordium with normally placed apex beat, grade 2 parasternal heave with single second heart sound and grade 3/6 continuous murmur along left mid sternal border. Twelve lead electrocardiogram (ECG) showed normal sinus rhythm, right axis deviation and right ventricular hypertrophy. There was no evidence of ischemia. Chest X-ray revealed "boat shaped heart" with oligaemic lung fields. Transthoracic echocardiography showed large conoventricular ventricular septal defect with bidirectional flow. There was aortic over-ride with dilated left main coronary artery. No forward flow was seen across right ventricular outflow tract. Considering hugely dilated left main coronary artery, suspicion of coronary to pulmonary artery fistula was made and cardiac computed tomography followed by conventional angiography was done, both confirmed the diagnosis of Tetralogy of Fallot with pulmonary atresia and large coronary artery to main pulmonary artery fistula as a primary pulmonary blood supply. Two small collaterals (MAPCAs) were also identified supplying small part of right and left lungs. Conclusion This case highlights unusual source of pulmonary blood supply in Tetralogy of Fallot with pulmonary atresia. Correct pre-operative diagnosis is essential for appropriate surgical planning and better outcome. Abstract P1727 Figure. TOF-PA with CA to PA Fistula

Multiple giant coronary artery aneurysms combined with right coronary artery-pulmonary artery fistula: a case report

BackgroundThe combination of multiple giant coronary artery aneurysms (CAAs) and right coronary artery (RCA) to pulmonary artery (PA) fistula is extremely rare and the patients with CAAs may suffer from several fatal complications. We herein describe a 60-year-old female with hemodynamic instability who was diagnosed with multiple giant CAAs combined with RCA-PA fistula.Case presentationThe patient, a 60-year-old female, presented to the emergency room because of progressive exertional chest distress and fatigue. The transthoracic echocardiography (TTE), coronary computed tomography angiography (CTA) and invasive coronary angiography confirmed the existence of multiple giant CAAs and RCA-PA fistula. Laboratory examinations for systemic vasculitis and infectious diseases demonstrated no abnormalities and work-up for childhood and family history were negative. We have performed a successful surgical treatment for this patient. The patient’s restrictive cardiac dysfunction was improved after debriding the advanced thrombi in aneurysm sac and ligating the fistulous vessel between the native RCA and PA. The postoperative pathologic examination of the aneurysmal wall revealed loss of smooth muscle cells in the media with local mucoid degeneration, no chronic inflammation, sclerosis and IgG4 were observed.ConclusionsThe treatment decision-making process should depend upon the patients’ specific situations. Our case suggests the surgical intervention should be accepted as the preferred treatment for giant CAAs with restrictive cardiac dysfunction.

The multiple systemic artery to pulmonary artery fistulas resulting in severe irreversible pulmonary arterial hypertension in patient with previous history of pneumothorax

BackgroundSystemic artery to pulmonary artery fistulas (SA-PAFs), are extremely rare in people without congenital heart disease. In this group of patients pulmonary arterial hypertension was reported in the single case. Then, we describe a case of multiple SA-PAFs, which were the cause of severe nonreversible arterial pulmonary hypertension in a patient who had a right-sided pneumothorax 35 years earlier.Case presentation52-year-old male Caucasian patient with echocardiographically confirmed pulmonary hypertension (PH) was admitted to cardiology department due to exertional dyspnea and signs of right ventricle failure. Routine screening for causes of secondary PH was negative. Right heart catheterization (RHC) confirmed a high degree arterial PH [mean pulmonary artery pressure (mPAP); 50,6 mmHg, pulmonary wedge pressure (PWP); 11,3 mmHg, pulmonary vascular resistance (PVR); 11,9 Wood’s units (WU)] irreversible in the test with inhaled nitric oxide. Oxygen saturation (SaO2) of blood samples obtained during the first RHC ranged from 69.3 to 73.2%. Idiopathic pulmonary arterial hypertension was diagnosed. Treatment with inhaled iloprost and sildenafil was initiated.Control RHC, performed 5 months later showed values of mPAP (59,7 mmHg) and PVR (13,4 WU) higher in comparison to the initial measurement, SaO2 of blood obtained during RHC from upper lobe artery of the right lung was elevated and amounted 89.7%.Then, pulmonary arteriography was performed. Lack of contrast in the right upper lobe artery with the evidence of retrograde blood flow visible as a negative contrast in the right pulmonary artery was found. Afterwards, right subclavian artery arteriography detected a huge vascular malformation communicating with right upper lobe artery. Following computed tomography angiogram (angio-CT) additionally revealed the enlargement of bronchial arteries originated fistulas to pulmonary artery of right upper lobe.In spite of intensive pharmacological treatment, including the therapy of pulmonary hypertension and percutaneous embolisation of the fistulas, the patient’s condition continued to deteriorate further. He died three months after embolisation due to severe heart failure complicated by pneumonia.ConclusionNon-congenital SA-PAFs are extremely rare, however, they should be excluded in patients with pulmonary arterial hypertension and history of inflammatory or infectious disease of the lung and pleura, pneumothorax, cancer or Takayashu’s disease and after chest trauma.

Thoracoscopic Bronchial Artery Resection for Multiple Bronchial Artery Aneurysms

We describe a 36-year-old asymptomatic female with multiple bronchial artery aneurysms (BAAs) and a bronchial artery (BA) to pulmonary artery (PA) fistula. She was treated with thoracoscopic BA resection without lobectomy in lieu of catheter embolization as first-line treatment. The configuration of the BA and the location of the BAAs were clearly visualized using three-dimensional computed tomography (3DCT); therefore, the segment of the BA to resect was assessed preoperatively and complete resection of all BAAs was performed. Preoperative BA angiography delineated the BA to PA fistula, and guided surgical decision-making.

Catheterization Performed in the Early Postoperative Period After Congenital Heart Surgery in Children.

The aim of this study was to describe pediatric patients who underwent early postoperative cardiac catheterization after congenital heart surgery, their clinical indications, findings, interventions, and complications in a cardiovascular center. A descriptive retrospective study was performed. All catheterizations performed within 6weeks after congenital heart surgery between January 2004 and December 2014 were reviewed. We analyzed 101 early postoperative catheterizations. They were performed on median postoperative day five (IQR: 0-39); the median age was 64days (IQR: 22-240). The most common diagnoses were single ventricle (53%), left heart obstruction (12%), and tetralogy of fallot or pulmonary atresia with ventricular septal defect (11%). Most common indications were persistent cyanosis (53%), low cardiac output (24%), and residual defect on echocardiogram (20%). Most frequent findings during the catheterization were pulmonary artery stenosis (29%), surgical conduit obstruction (12%), and coarctation or hypoplasia of the aorta (11%). Forty-six (45%) procedures involved intervention. Most frequent interventions were pulmonary artery, aorta, and Blalock-Taussig fistula angioplasty with or without stent implantation. There were adverse effects in 11 cases (11%), and 30-day mortality was 28% (28 patients) with the majority unrelated to the catheterization directly. Although early postoperative catheterizations are high-risk procedures, they are currently a very good option to solve acute problems in critically ill patients. This study provides relevant information for a better understanding and approach to this complex group of patients.

LEFT INTERNAL MAMMARY ARTERY TO PULMONARY ARTERY STEAL RESULTING IN POST-CORONARY ARTERY BYPASS GRAFTING CORONARY ISCHEMIA

We present a rare case of coronary steal syndrome secondary to formation of a left internal mammary artery - pulmonary artery (LIMA-PA) fistula after coronary artery bypass grafting (CABG). A 71 year-old presented to clinic with angina. Past medical history included ischemic cardiomyopathy status

Two cases of coronary to pulmonary artery fistulas treated with surgical closure

Two cases of coronary to pulmonary artery fistulas treated with surgical closure

Coronary to Pulmonary Artery Fistula as a Main Source of Pulmonary Blood Flow in Pulmonary Atresia and Ventricular Septal Defect

Coronary to Pulmonary Artery Fistula as a Main Source of Pulmonary Blood Flow in Pulmonary Atresia and Ventricular Septal Defect

Minimally Invasive Surgery for Coronary-Pulmonary Artery Fistula Via Parasternal Minithoracotomy

Epicardial surgical repair has been proven to be effective for patients with coronary- pulmonary artery fistula (CPAF). However, most of the surgery has been performed through a median sternotomy under cardiopulmonary bypass. In this report, we describe a novel technique of performing minimally invasive surgery for CPAF patients without extracorporeal circulation via a parasternal minithoracotomy. This technique has proved to be safe and effective and may be worthy of use for patients with CPAF.

Tiny ruptured coronary aneurysm with coronary-pulmonary arterial fistula

A 44-year-old man was admitted to our hospital with chest pain. We diagnosed him with pericardial effusion collection because of a spontaneous ruptured coronary aneurysm of 1.5 cm with coronary pulmonary arterial fistula (CPAF) by enhanced computed tomography and angiography. We completely resected the ruptured aneurysm and safely closed the CPAF. Rupture of coronary aneurysms with CPAF is rare, especially tiny aneurysms. In previous reports, most cases were older women and the diameter of the ruptured aneurysms was greater than 3.0 cm. We report a case of a middle-aged man with a tiny ruptured coronary aneurysm with CPAF.

Ruptured Giant Coronary Artery Aneurysm With Coronary Artery to Pulmonary Artery Fistula Presenting as Cardiac Tamponade Diagnosed by Intraoperative Transesophageal Echocardiography: A Case Report.

A 63-year-old woman presented with cardiac tamponade because of a ruptured giant left anterior descending coronary artery aneurysm with a fistula to the main pulmonary artery. The diagnosis was made intraoperatively during an emergent subxiphoid pericardial window using transesophageal echocardiography and confirmed by intraoperative coronary angiography. Because of this prompt diagnosis, the patient was successfully managed with immediate surgical repair of the aneurysm and fistula.

Resolution of exertional angina after coil embolization of coronary to pulmonary artery fistula

Additional supporting information may be found online in the Supporting Information section at the end of the article. Video S1. Baseline Echocardiogram Showing Reduced Left Ventricular Function. Video S2. The Coil Embolization Procedure. Video S3. Follow up Coronary Angiography at 60-days. Video S4. Follow up Echocardiogram Showing Improvement in Left Ventricular Function. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Coronary Artery Fistulas: Pathophysiology, Imaging Findings, and Management-Erratum.

HomeRadioGraphicsVol. 38, No. 7 Previous ErrataFree AccessCoronary Artery Fistulas: Pathophysiology, Imaging Findings, and Management—ErratumGabin Yun, Tae Hyun Nam, Eun Ju ChunGabin Yun, Tae Hyun Nam, Eun Ju ChunGabin YunTae Hyun NamEun Ju ChunPublished Online:Nov 13 2018https://doi.org/10.1148/rg.2018184013MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Originally published in:RadioGraphics 2018; 38(3):688–703 • https://doi.org/10.1148/rg.2018170158Coronary Artery Fistulas: Pathophysiology, Imaging Findings, and ManagementGabin Yun, Tae Hyun Nam, Eun Ju ChunErratum in:RadioGraphics 2018:38(7):2214 • https://doi.org/10.1148/rg.2018184013Second paragraph, page 690: The first sentence should read as follows: “Transthoracic or transesophageal echocardiography [not ECG] can be used to delineate the anatomy of CAFs and determine hemodynamic changes without the use of ionizing radiation or contrast material.”Table 1, page 691: The heading in the second row, first column, should be “Echocardiography” [not ECG].Article HistoryPublished online: Nov 13 2018Published in print: Nov 2018 FiguresReferencesRelatedDetailsCited ByCTA analysis of 482 cases of coronary artery fistula: A large‐scale imaging studyRenhuiCai, XiaojingMa, XinxiangZhao, JuanXu, LiZhu, LeizhiKu2022 | Journal of Cardiac Surgery, Vol. 37, No. 7Colossal left main to right atrium fistula ligation complicated by left circumflex STEMIGiorgio A.Medranda, ShannonLance, RonWaksman, Nelson L.Bernardo2021 | Catheterization and Cardiovascular Interventions, Vol. 97, No. 6Cardiac-CT with the newest CT scanners: An incoming screening tool for competitive athletes?GiancarloSavino, Francesca LoPiccolo, BiagioMerlino, GiuseppeRovere, MassimilianoBianco, Salvatore FrancescoGervasi, VincenzoPalmieri, Anna RitaLarici, RiccardoManfredi, RiccardoMarano2021 | Clinical Imaging, Vol. 78Coronary artery fistulas detected with coronary CT angiography: a pictorial review of 73 casesNingLi, PengZhao, DaweiWu, ChanghuLiang2020 | The British Journal of Radiology, Vol. 93, No. 1108Accompanying This ArticleCoronary Artery Fistulas: Pathophysiology, Imaging Findings, and ManagementMar 30 2018RadioGraphicsRecommended Articles Adult-type Anomalous Origin of the Left Coronary Artery from the Pulmonary ArteryRadiology2021Volume: 300Issue: 2pp. 287Congenital Coronary Artery–to–Pulmonary Artery Fistula with Anomalous Origin of Right Coronary Artery from Pulmonary Artery: A Case of “Double Trouble”Radiology: Cardiothoracic Imaging2021Volume: 3Issue: 4Anomalous Coronary Arteries That Need Intervention: Review of Pre- and Postoperative Imaging AppearancesRadioGraphics2017Volume: 37Issue: 3pp. 740-757Multimodality Imaging for More Accurate Diagnosis and Risk Assessment in Infective EndocarditisRadiology2020Volume: 297Issue: 2pp. 342-343Coronary Artery Aneurysm in Kawasaki Disease: Coronary CT Angiography through the Lens of Pathophysiology and Differential DiagnosisRadiology: Cardiothoracic Imaging2021Volume: 3Issue: 5See More RSNA Education Exhibits Coronary Artery Termination Variations and AnomaliesDigital Posters2018Assessment of Coronary Artery Fistulas by Computed Tomographic Angiography (CTA)Digital Posters2018MSCTÂ Imaging of Unusual Coronary to Pulmonary Circulation FistulaeDigital Posters2018 RSNA Case Collection Anomalous Left Coronary Artery from Pulmonary Artery (ALCAPA)RSNA Case Collection2020Anomalous origin of the right coronary artery from the left sinus of ValsalvaRSNA Case Collection2020Pulmonary AtresiaRSNA Case Collection2022 Vol. 38, No. 7 Metrics Altmetric Score PDF download

Significance of Coronary Artery to Pulmonary Artery Fistulae in Takayasu Arteritis

Significance of Coronary Artery to Pulmonary Artery Fistulae in Takayasu Arteritis

Secondary systemic artery to pulmonary artery and pulmonary vein fistulas following the video-assisted thoracic surgery for pneumothorax: a case report

BackgroundThe systemic artery to pulmonary vessel fistula (SAPVF) is a vascular anomaly characterized by penetration of nonbronchial systemic chest wall arteries into the lung parenchyma. To our knowledge, about 150 cases of SAPVF have been reported to date. Fifteen percent of SAPVF are congenital and occur in the presence of cardiopathy or pulmonary artery hypoplasia. Secondary SAPVF are caused by pleural adhesions that occur subsequent to inflammatory changes associated with conditions such as pleuritis, empyema, trauma, and surgery. Though several cases of secondary SAPVF as a post coronary artery bypass graft (CABG) complication have been reported, secondary SAPVF especially following video-assisted thoracic surgery (VATS) are relatively rare.Case presentationA 19-year-old man was admitted to our hospital because of recurrence of left pneumothorax. His previous history included left and right pneumothorax at the ages of 15 and 16 years, respectively, which were treated by VATS. VATS was planned for the surgical indication of second postoperative recurrence. In the operation, the lingular segment with dilated pulsating pulmonary vessels adhered to the port scar of the chest wall, which was made at first VATS for pneumothorax. The computed tomography showed an abnormal connection between the branch of the systemic artery of the chest wall and the dilated pulmonary artery and pulmonary vein in the lingular segment. Left subclavian selective arteriography also showed hypertrophic blood vessels arose from the internal thoracic artery, the lateral thoracic artery, and the subscapular artery, which drained into the both the pulmonary artery and the pulmonary vein in the lingular segment. Despite of four sessions of embolization for aberrant arteries, the abnormal blood flow persisted. Partial resection of the left lingular segment was therefore performed. The patient has been disease-free about SAPVF for 2 years and 2 months after the last operation.ConclusionsWe described our experience with a case of secondary SAPVF that was associated with fistulas between a systemic artery and both the pulmonary artery and pulmonary vein, which was developed after first VATS for pneumothorax. Radical resection was safely performed and effective after four sessions of embolization.