A Case of Bilateral Coronary to Pulmonary Artery Fistulas Associated With Severe Aortic Regurgitation

Abstract

Coronary artery fistula (CAF) is a rare form of congenital anomalies of the coronary arteries, and this is usually discovered by chance during coronary angiography. However, this type of fistula can cause important coronary morbidity and mortality leading to angina, syncope, congestive heart failure, myocardial infarction and sudden death. Bilateral CAFs are even rarer, and especially when combined with valvular heart disease. The coincidence of CAF with aortic regurgitation is relatively rare and this might sometimes cause myocardial ischemia. We present here a case of bilateral coronary-pulmonary artery fistulas that arose from the first diagonal branch of the left anterior descending artery and the conal branch of the right coronary artery combined with severe aortic regurgitation, and this all caused myocardial ischemia.

Innovative method to diagnose coronary Cameral fistula by contrast echocardiography

“…Previously, CAF has been diagnosed with aortography, 10 coronary angiography, 11 and coronary CT 13 . Although there has been a case of color Doppler assessment of a CAF, 12 we cannot readily confirm them with echocardiography.…”

A Case Report of Coronary Arteriovenous Fistulas with an Unruptured Coronary Artery Aneurysm Successfully Treated by Surgery

“…CAVF is defined as abnormal communications between the coronary arteries and cardiac chambers, great arteries, or vena cava. Although young patients are often asymptomatic, two-thirds of patients aged >20 years present clinical symptoms of heart failure, pulmonary hypertension, or angina pectoris [ 2 , 3 ]. CAVF accounts for 14% of congenital coronary malformations [ 4 ] and is detected by chance in 0.1%-0.2% of CAG [ 5 , 6 ].…”

Contrast Echo-A Simple Diagnostic Tool for a Coronary Artery Fistula

“…Coronary artery fistulas have been diagnosed with aortography,8) coronary angiography,9) and coronary CT 7). Although there is a case of colour Doppler assessment of a coronary fistula,10) we cannot easily confirm these fistulas with echocardiography.…”

“…Many patients are asymptomatic; however, an awareness of these fistulas is important because they have been associated with various clinical features including chest pain or heart failure in young patients. 7) Coronary artery fistulas have been diagnosed with aortography, 8) coronary angiography, 9) and coronary CT. 7) Although there is a case of colour Doppler assessment of a coronary fistula, 10) we cannot easily confirm these fistulas with echocardiography. In this study, we used a simple diagnostic approach for a coronary artery fistula using a contrast agent, which aided with the diagnosis, because of the typical diastolic whitish flow in the pulmonary artery.…”