Coronary artery fistula detected with transesophageal echocardiography: An unexpected cause of pulmonary hypertension and chest pain (original) (raw)
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Turkish Journal of Thoracic and Cardiovascular Surgery
A 28-year-old female was admitted to our hospital with complaints of palpitations and fatigue. The patient's medical history was unremarkable. The physical examination revealed a hyperkinetic precordium (heart rate 108/min) and a continuous murmur (systolodiastolic) on the right side of the sternum. The patient's blood pressure was 120/70 mmHg. Electrocardiogram revealed atrial fibrillation with a high ventricular rate. Two-dimensional transthoracic echocardiography (TTE) detected a markedly enlarged right atrium and aneurysmatic right coronary ostium with no abnormalities of other cardiac structures (Figure 1a). The left ventricular ejection fraction was 60%. Selective coronary angiography revealed a tunnel-like connection that seemed like a fistula extending from the right coronary sinus of Valsalva to the right atrium (Figure 1b). The pulmonary-to-systemic blood flow ratio (Qp/Qs) was assessed as 1.18 during right cardiac catheterization. The pulmonary artery pressure was 32 mmHg. The images obtained with cardiac multidetector computed tomography (MDCT) revealed a dilated tunnel coursed from the right coronary sinus to the An extremely rare coronary artery fistula extending from the sinoatrial nodal artery to the right atrium Sinoatriyal düğüm arterinden sağ atriyuma uzanan oldukça ender bir koroner arter fistülü
Journal of the American College of Cardiology, 1985
A coronary-cameral fistula was inspected clinically by two-dimensional and pulsed Doppler ultrasound. At car• diac catheterization a fistulous connection between the left coronary artery and the right ventricle was observed. Contrast echocardiography using agitated saline solution injected into the aortic catheter clearly showed the pas-Congenital fistulas of the coronary arteries, first described by Krause in 1965 (l), may involve a variety of fistulous connections to the cardiac chambers or surrounding large vessels (2,3). In more than 90% of reported cases, the fistula drained into the systemic venous circulation (right ventricle, right atrium, pulmonary artery and coronary sinus), whereas there were only a few reported cases (4-6) in which it drained into the left ventricle. This report is the first to describe the connection of a left coronary artery fistula to both ventricles, the demonstration of which required con• trast echocardiography during the cardiac catheterization. Case Report A 3 year old asymptomatic girl had a heart murmur noted since the age of 6 months. A high-pitched grade 2/6 con• tinuous murmur was heard over the cardiac apex with sys• tolic and diastolic components of equal intensity. Serial electrocardiograms and chest rentgenograms were normal. A two-dimensional echocardiogram was performed using a Mark 600 ATL mechanical scanner with full spectral Dop• pler output and a 5 MHz transducer. An enlarged left coro• nary artery with two echolucent areas in the apical inter• ventricular septum was noted (Fig. I). Doppler insonation
Pediatric Radiology, 2011
Coronary artery fistula is a connection between coronary artery and its branch to any of the cardiac chamber, great vessel or coronary sinus bypassing the myocardial capillary bed. Majority of fistulas are congenital in origin, although acquired fistulas may be encountered occasionally after cardiac surgery, endocarditis and after repeated myocardial biopsies (Somers and Verney, Clin Radioly 44:419-421, 1991). We report a 55-year-old female patient of large coronary cameral fistula between sinoatrial nodal artery and right atrium. She presented with congestive heart failure, atrial fibrillation and deterioration of left ventricular function with mitral regurgitation with functional class 3. The patient was managed with closure of origin of fistula from inside the aorta using polytetrafluoroethylene (PTFE) patch of 1.5×1.5 cm, on cardiopulmonary bypass using blood cardioplegia, as rest of the right coronary artery (RCA) was rudimentary. She had uneventful recovery with improvement in the functional class 1.
Echocardiography, 2011
A 49-year-old female who presented with 3 weeks of exertional chest pain had an abnormal mediastinal finding at chest x-ray imaging. Conventional, nongated computed tomography of the chest revealed a "mass" in proximity to the right atrium. 64-slice, cardiac gated computed tomographic coronary angiography, and transesophageal echocardiography delineated the "mass" as a coronary artery fistula structure. The fistula originated from the left main as a tubular vessel that continued into an aneurysmal sac-like cavity that emptied into the superior vena cava near the right atrium. Computed tomographic coronary angiography showed otherwise normal coronary arteries. Findings were ultimately confirmed at cardiac catheterization. Coronary steal was clinically diagnosed and she underwent surgical ligation and resection of the fistula and aneurysm. Her subsequent course was uncomplicated. (Echocardiography 2012;29:E69-E71)
Right coronary artery-to-pulmonary artery fistula, the role of echocardiography
Coronary artery fistula is an uncommon but hemodynamically significant anomaly of the coronary arteries, occurring as an incidental finding in 0.1% to 0.2% of coronary angiograms. Although half of the patients with a coronary artery fistula remain asymptomatic, the other half develops CHF, infective endocarditis, myocardial ischemia, or rupture of an aneurysm. This report is illustrative of the right coronary artery fistula to the right pulmonary artery in a 57-year-old male. The definitive diagnosis was made during transesophageal echocardiography and confirmed at operation.
Giant Left Circumflex Coronary Fistula to the Right Atrium
Circulation, 2010
A 49-year-old man with multiple coronary risk factors, including diabetes mellitus, hypertension, and hyperlipidemia, was referred for coronary angiography for evaluation of mild dyspnea on exertion and atypical chest pains. An exercise nuclear stress test demonstrated mild, reversible ischemia in the mid and distal inferior wall. The patient subsequently underwent cardiac catheterization, which demonstrated a giant coronary arterial-venous (A-V) fistula arising from a markedly dilated and tortuous circumflex artery ( ). The vessel course could not be well delineated because of its tortuosity and the inability to fully opacify this structure with contrast. The other primary epicardial coronary arteries were angiographically normal. A small left-to-right shunt was detected, with Qp/Qsϭ1.29.
Case report of coronary artery fistula
Medicine, 2019
Rationale: Unlike invasive coronary angiography and echocardiography, cardiac computed tomography (CCT) and cardiac magnetic resonance (CMR) imaging allow a coronary artery fistula (CAF) comprehensive evaluation focusing on both coronary and myocardial findings. Patient concerns: We present the case of an asymptomatic patient suspected for CAF and referred to our structure for cardiovascular evaluation. Diagnosis: The patient was diagnosed a CAF without coronary artery disease on the basis of CMR and CCT. Interventions: The patient underwent an invasive coronary angiography after which the medical staff decided not to surgically treat the CAF. Therefore, a conservative treatment was chosen with strict temporal monitoring. Outcomes: After less than 1 year follow-up, the patient presented stable conditions without complaints. Lessons: Multimodal non-invasive imaging has a key role in patient assessment for disease diagnosis providing better understanding for prognosis and treatment. Abbreviations: CAF = coronary artery fistula, CCT = cardiac computed tomography, CMR = cardiac magnetic resonance, CR = cinematic rendering, EDV = end-diastolic volume, EF = ejection fraction, ESV = end-systolic volume, LAD = left anterior descending artery, LCX = circumflex coronary artery, RCA = right coronary artery, SSFP = cine steady state free precession, STIR = short Tau inversion recovery, VR = volume rendering.
Journal of cardiology, 2007
Right coronary artery to left ventricle fistula is a rare type of coronary artery fistula among congenital coronary artery anomalies. Most patients exhibit no symptoms and some experience chest pain. Coronary angiography sometimes detects the presence of coronary artery fistula, but not coronary arteriosclerosis. A 76-year-old man with unstable angina was admitted because he did not respond to drug therapy. Coronary angiography showed three-vessel coronary artery disease and the contrast agent entered the left ventricle from the terminal of the right coronary artery during diastole. Multidetector-row computer tomography showed similar findings. The patient subsequently underwent coronary artery bypass grafting and obliteration of the coronary artery fistula. The chest pain was relieved and he is now in good condition.