Atypical Presentation of Coronary Artery Fistula: Case Report and Review of the Literature (original) (raw)

Coronary artery fistula: An unusual cause of chest pain in a young adult

Catheterization and Cardiovascular Interventions, 2011

Coronary artery fistula, usually congenital in origin, is an abnormal communication between a coronary artery and a cardiac chamber or great vessel [coronary sinus, pulmonary artery, pulmonary vein, or super vena cava (SVC)]. A coronary fistula can produce high-output heart failure from volume overload and/or myocardial ischemia from coronary steal phenomenon. A 35-year-old man was found to have a large fistula from the left circumflex coronary artery to the SVC-right atrium junction, an extremely rare anomaly. This patient developed right ventricular dysfunction and chest pain due to myocardial ischemia in the left circumflex coronary artery distribution for several months before evaluation. Because of the large size of the fistula, surgical ligation was chosen instead of coil embolization to close the fistula. The patient was free of chest pain postprocedure. Coronary artery fistulas, though rare, should be considered in the differential diagnosis when a young patient presents with chest pain and/or heart failure. V

Coronary artery fistula: A case series with review of the literature

Journal of Cardiology, 2009

Coronary artery fistula (CAF) is an anomalous connection between a coronary artery and a major vessel or cardiac chamber. Most of the coronary fistulas are discovered incidentally during angiographic evaluation for coronary vascular disorder. The management of CAF is complicated and recommendations are based on anecdotal cases or very small retrospective series. We present three cases of CAF, two of which were symptomatic due to hemodynamically significant coronary steal phenomenon. They underwent successful transcatheter coil embolization, leading to resolution of their symptoms. Percutaneous closure offers a safe and effective way for the management of symptomatic patients. CAFs are rare cardiac anomalies but can give rise to a variety of symptoms because of their hemodynamic consequences or complications. They should be part of cardiac differential diagnosis particularly in patients without other risk factors. Correction of CAF is indicated if the patients are symptomatic or if other secondary complications develop.

A case of symptomatic coronary artery fistula

Nature Clinical Practice Cardiovascular Medicine, 2006

This article offers the opportunity to earn one Category 1 credit towards the AMA Physician's Recognition Award. Diagnosis Right coronary artery to coronary sinus fistula with coronary steal, exertional ischemia and ventricular arrhythmia. Management Coil embolization of coronary left ventricular fistula.

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.

Coronary artery fistulas: Clinical and therapeutic considerations

International Journal of Cardiology, 2006

Coronary artery fistulas vary widely in their morphological appearance and presentation. These fistulas are congenital or acquired coronary artery abnormalities in which blood is shunted into a cardiac chamber, great vessel, or other structure, bypassing the myocardial capillary network. The majority of these fistulas arise from the right coronary artery and the left anterior descending coronary artery; the circumflex coronary artery is rarely involved. Clinical manifestations vary considerably and the long-term outcome is not fully known. The patients with coronary fistulas may present with dyspnea, congestive heart failure, angina, endocarditis, arrhythmias, or myocardial infarction. A continuous murmur is often present and is highly suggestive of a coronary artery fistula. Differential diagnosis includes persistent ductus arteriosus, pulmonary arteriovenous fistula, ruptured sinus of Valsalva aneurysm, aortopulmonary window, prolapse of the right aortic cusp with a supracristal ventricular septal defect, internal mammary artery to pulmonary artery fistula, and systemic arteriovenous fistula. Although noninvasive imaging may facilitate the diagnosis and identification of the origin and insertion of coronary artery fistulas, cardiac catheterization and coronary angiography is necessary for the precise delineation of coronary anatomy, for assessment of hemodynamics, and to show the presence of concomitant atherosclerosis and other structural anomalies. Treatment is advocated for symptomatic patients and for those asymptomatic patients who are at risk for future complications. Possible therapeutic options include surgical correction and transcatheter embolization. Historical perspectives, demographics, clinical presentations, diagnostic evaluation, and management of coronary artery fistula are elaborated. D

Coronary artery fistula: Review of 54 cases from single center experience

Cardiology journal, 2012

Background: Demographic and clinical characteristics and angiographic findings of Turkish patients with coronary artery fistula have been investigated in this study and diagnostic tests and treatment methods used in these patients have also been evaluated in detail. Methods: We have examined the cardiac catheterization laboratory database retrospectively between March 2006 and July 2010. Among 49,567 patients, we have noted 60 patients diagnosed as coronary artery fistula. After coronary angiographic images were ...

Coronary Artery Fistulae: Anatomy, Diagnosis and Management Strategies

Heart, lung & circulation, 2018

Coronary artery fistula (CAF) is a relatively rare anatomic abnormality of the coronary arteries that afflicts 0.002% of the general population and represents 14% of all the anomalies of coronary arteries. Its clinical relevance focusses mainly on the mechanism of "coronary steal phenomenon", causing myocardial functional ischaemia even in the absence of stenosis, hence common symptoms are angina or effort dyspnoea. The suggested diagnostic approach is guided by the patient's symptoms and consists of a number of instrumental examinations like ECG, treadmill test, echocardiography, computed tomography scan, cardiac magnetic resonance and coronary angiography. If it is not an incidental finding, coronary angiography is required in view of the optimal therapeutic planning. Small sized fistulae are usually asymptomatic and have an excellent prognosis if managed medically with clinical follow-up with echocardiography every 2 to 5 years. In the case of symptomatic, large-siz...