Coronary-pulmonary fistula: long-term follow-up in operated and non-operated patients (original) (raw)
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Coronary pulmonary artery fistula: A case series with review of the literature
Objective: To describe the clinical, angiographic profile and management strategies of patients of coronary pulmonary arterial fistulas presenting to a tertiary care center in a developing country. Methods: All patients with coronary pulmonary artery fistula (CPAF) diagnosed using coronary angiogram in last two years i.e. 2011-2013 in a tertiary care center in South India were included in the study. Ten adult patients were treated for coronary pulmonary artery fistulas. Results: Mean age was 56± 7.7 years (range 45-80 years) with no gender preponderance. Chest pain was the predominant symptom in 60 % of patients followed by giddiness and syncope. Only 20 % patients were found to have continuous or systolic murmur on auscultation. Majority of the fistulas were found to be originating from the left anterior descending artery (LAD), most commonly from proximal segment (n = 5). Majority (n = 9) responded to conservative management while one patient required surgical intervention. Conclusion: Coronary pulmonary arterial fistulas are rare coronary anomaly which often goes unnoticed. CPAF was most frequently seen in middle age with male preponderance arising from proximal LAD. Patients present with diverse clinical presentations and subtle clinical findings. Majority of them being functionally insignificant, need only conservative measures.
Journal of the Saudi Heart Association, 2012
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.
Surgical treatment of coronary-to-pulmonary fistula: how and when?
Heart and Vessels, 2006
Coronary arteriovenous fistulas (CAVF) are rare malformations. Opinions vary on which operation should be offered to these patients, particularly those asymptomatic. We report four patients operated on for CAVF referred to our institution over the course of a year. Three patients had associated cardiac lesions. In all of them CAVF was identified and closed with running sutures. There was no operative mortality or operative morbidity. All patients were asymptomatic at follow-up. In patients undergoing surgical treatment of cardiac disease, associated CAVF should always be treated. Although in patients with giant CAVF it is safer to patch the outflow of CAVF from the outflow chamber, in the majority of cases CAVF should be identified intraoperatively and closed with multiple running stitches.
OALib, 2016
Coronary artery fistulas (CAF) are precapillary communications between a coronary artery and a cardiac chamber or vessel. CAF have been described as the most common hemodynamically significant congenital coronary anomal. However, it remains a relatively uncommon clinical problem. Coronary fistulas originates slightly more common from the right than from the left coronary artery, but the bilateral fistulas-those that originate from both coronary arteries-accounts for only 5% of total cases. These bilateral fistulas have a unique tendency to terminate in the pulmonary artery. More than half of the bilateral and only 17% of unilateral fistulas, terminates in this manner [1]. CAF are believed to be embryological remnants of sinusoidal connections between the lumens of the primitive tubular heart. This was first described by Maude Abbott in 1908 [2]. These fistulas are usually discovered incidentally upon coronary angiography [3]. Their incidence in the overall population is reported about 0.002% and constitutes 0.13% of congenital cardiac lesion, however, they are found in 0.05% to 0.25% of patients who undergo coronary angiography. The most common site of drainage is the right ventricle seen in 41% of patients. Congenital CAFs usually result from abnormal embryological development of the myocardial vascular system. Acquired CAFs are seen after trauma, endovascular procedures like coronary angiography, endomyocardial biopsy etcor cardiac transplantation. True fistulas of the circulatory system are characterized by an ectatic vascular segment that shows aberrant flow connecting two vascular territories governed by large pressure differences. We report a case of double coronary to pulmonary artery fistula discovered during emergent coronary angiography for acute inferior wall ST-elevation myocardial infarction (STEMI) in a patient with no prior cardiac symptoms.
Surgical Repair of Fistula Between Right Coronary Artery and Main Pulmonary Artery: Case Report
Osmangazi tıp dergisi, 2021
Coronary artery fistulas (CAF) are uncommon cases. They may cause myocardial ischemia, arrhythmia, pulmonary hypertension, and heart failure. Treatment options are controversial and not clear. In this article we report surgical management of a case with right coronary artery fistula and concurrent coronary artery disease. A sixty-years-old male patient with stable angina symptoms admitted to our medical center. Coronary angiography examination showed a right coronary artery to pulmonary artery fistula and significant right coronary artery lesion located after the fistula's origin. CAF ligated epicardially and right coronary revascularization was performed. Coronary arterial fistulas cause important hemodynamic problems. Surgical and transcatheter interventional treatments are treatment options. Therefore indications for treatment are very important for these patients. The best therapeutic strategy (surgery or transcatheter intervention) is debatable. The surgical treatment is controversial especially for asymptomatic and small fistulas. However, there is consensus that large and symptomatic fistulas should be treated. Further research is necessary to deepen these observations.
Coronary Artery Fistulas Between Coronary and Pulmonary Arteries: Case Reports
Journal of Clinical and Analytical Medicine, 2016
Konjenital koroner arter fistülü bir koroner arter ile diğer vasküler yapılar arasında direkt bağlantının olduğu nadir, izole bir anomalidir. Biz biri perkütan koil embolizasyon uygulaması ile, diğeri cerrahi olarak tedavi edilmiş iki konjenital koroner arteriyovenöz fistüllü vakayı sunduk.
Coronary Artery Fistula: Single-Center Experience Spanning 17 Years
Journal of Interventional Cardiology, 2007
Coronary artery fistula (CAF) is an uncommon form of congenital heart disease. It is often diagnosed incidentally during angiograms. We have reported on clinical characteristics, diagnosis, and management of CAF. Retrospective review of a tertiary referral institution's database identified 30 patients with CAF between 1987 and 2004. Mean follow-up was 31.61 +/- 48.03 months. Mean age was 60 +/- 12.7 years. Most common site of CAF origin was the left anterior descending artery (LAD) (14, 46.7%). The most common site of drainage was the main pulmonary artery (15, 50%). Therapeutic strategies were based on symptoms and shunt size. Conservative management was the option in 17 patients (56.7%) with small shunts and mild or no symptoms. Patients with moderate/severe symptoms and/or large shunts were treated with either percutaneous embolization (6, 20%) or surgical ligation (7, 23.3%). Four patients (13.3%) died during follow-up. No deaths were reported in the embolization group, two patients died of cancer in the conservative management group, and two patients died in the surgical group due to cardiac tamponade and cancer, respectively. Origin of CAF was predominantly from the left system. Clinical presentations were variable depending on type, size of fistula, and the presence of other cardiac conditions. Management of CAF is still controversial and treatment of adult asymptomatic patients with nonsignificant shunting is still a matter of debate. Newer imaging modalities may enhance noninvasive diagnosis. A national registry is necessary for further insights into optimal treatment for large fistulae and the natural history of smaller fistulae.
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.
Symptomatic bilateral coronary artery fistula to pulmonary artery in elderly patient
European journal of radiology open, 2016
We report the imaging findings of an uncommon coronary vascular termination anomaly, with fistula to the pulmonary artery. This 70 year old female patient presented unstable angina, showing a coronary artery fistula depicted in coronary angiogram from the left coronary to the pulmonary artery, with no significant atherosclerotic pathology. Due to development of ventricular tachycardia in stress echocardiogram examination, she was proposed for coronary fistula closure. Coronary CT was performed for procedure planning and allowed the identification of a second unsuspected fistula from the right coronary to the right pulmonary artery. Congenital coronary anomalies are a possible cause of symptomatic coronary pathology in patients of any age. In older patients, coronary artery fistulas are rare, especially when symptomatic. Adequately performed CT examinations, using its post processing capabilities, with 3D and MIP reconstructions are invaluable in delineating coronary anatomy, essenti...