A case of coronary artery fistula with mitral stenosis

Gündüz, Hüseyin; Akdemir, Ramazan; Binak, Emrah; Ayarcan, Yasemin; Kurtoğlu, Nuri; Uyan, Ci̇hangi̇r

doi:10.1023/b:caim.0000004261.56315.f5

Cited by 9 publications

(12 citation statements)

References 9 publications

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“…Chest X-ray can reveal pulmonary artery enlargement and cardiomegaly. In electrocardiographic investigation, right ventricular hypertrophy, right bundle branch block, left bundle branch block and ischemic changes can be seen [6][7][8]. In our case a myocardial ischemia or significant shunt was not documented.…”

Section: Discussionmentioning

confidence: 44%

“…The most significant complications are pulmonary hypertension due to large left-right shunt, bacterial endocarditis, aneurismal dilatation, rupture or thrombosis of the fistula and myocardial ischemia [7]. Coronary arteriovenous fistula may be discovered during the evaluation of a continuous murmur at the precordium and are usually diagnosed incidentally at coronary angiography.…”

Section: Discussionmentioning

confidence: 99%

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Coronary Arteriovenous Fistula in a Child Presenting with Chest Pain

Arslan¹,

Çimen²,

Oran³

et al. 2016

Ann Clin Anal Med

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Section: Discussionmentioning

confidence: 44%

Section: Discussionmentioning

confidence: 99%

Coronary Arteriovenous Fistula in a Child Presenting with Chest Pain

Arslan¹,

Çimen²,

Oran³

et al. 2016

Ann Clin Anal Med

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“…1 The relevance rating is based on the potential association of CAF with angina, syncope, congestive heart failure, myocardial infarction, and death. 2 Anesthesiologists and cardiac surgeons should be aware that a CAF is difficult to diagnose in the presence of valvular pathology. While this case illustrates the rare coexistence of CAF along with valvular abnormalities, [3][4][5] it presents a set of circumstances with unusual diagnostic and management challenges.…”

Section: To the Editormentioning

confidence: 99%

An echolucent structure on the anterolateral wall of the right atrium

Singh

2009

Can J Anesth/J Can Anesth

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A 34-year-old patient was diagnosed with mitral regurgitation (MR) on routine examination. A transthoracic echocardiogram revealed a bileaflet prolapse, moderately severe regurgitation (regurgitant fraction 39%), a dilated left ventricle (left ventricular end-diastolic diameter = 6.9 cm), and impaired left ventricle (LV) systolic function with an ejection fraction (EF) of 56% (in context of MR). As part of his participation in a clinical trial, the patient also received a magnetic resonance imaging (MRI) scan which confirmed significant LV dilatation and the presence of systolic dysfunction. Based on these findings, mitral valve surgery was planned.An intraoperative transesophageal echocardiography (TEE) revealed an unusual echo on the anterolateral surface of the right atrium which, after the pericardium was opened, was confirmed as being a dilated right coronary artery (RCA) (Fig. 1). In addition, a large leash of blood vessels was found on the right ventricle. Due to the presence of the thrill of a pansystolic murmur, it was impossible to delineate if a fistula was associated with the dilated RCA. However, there was excessive blood return in the surgical field (even with caval snares in place), suggesting the presence of a fistula. After an attempted repair failed, the mitral valve was replaced with a mechanical valve and an annuloplasty ring. The patient was successfully weaned from cardiopulmonary bypass and he recovered uneventfully. On follow up, the patient remains well, but he continues to have a soft continuous murmur most likely due to a fistula.The related TEE and clinical findings of this case presented an interesting diagnostic and management dilemma. The diagnosis of the echolucent structure was apparent from direct inspection of the surgical field, but the presence or absence of a large fistula could not be established by echocardiography. After careful consideration and discussion, the surgeons decided not to explore the lesion further in the absence of volume overload of the right ventricle. A retrospective examination of the MRI revealed a dilated RCA (Fig. 2) that had been overlooked in the initial report. Had this been known at the time, a coronary angiogram would have been performed based on the association between the ectasia of the coronary arteries and the presence of a fistula.Mitral valve prolapse, coronary artery ectasia, and coronary artery fistulae (CAF) occur in 2-3%, 0.3-5.3%, and 0.08-0.3% of patients, respectively. Coronary artery fistulae are rare and mostly congenital in origin. They generally represent an incidental finding on coronary angiography, and their diagnosis is described as ''Class II-Relevant'' based on the classification of coronary artery anomalies in adults. 1 The relevance rating is based on the potential association of CAF with angina, syncope, congestive heart failure, myocardial infarction, and death. 2 Anesthesiologists and cardiac surgeons should be aware that a CAF is difficult to diagnose in the presence of valvular pathology. While this case illustrates...

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“…[5][6][7][8][9] Several cases of coronary to pulmonary artery fistula combined with valvular heart disease, principally mitral stenosis, have been reported. [6][7][8] CAFs combined with severe aortic regurgitation are relatively rare in adults.…”

Section: )15)mentioning

confidence: 99%

“…CAFs arising from two coronary arteries are even rarer, especially when they are combined with valvular heart disease. [6][7][8][9] Furthermore, a few cases of coronary-pulmonary artery fistula combined with aortic regurgitation have been previously reported.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2008

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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.

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A case of coronary artery fistula with mitral stenosis

Cited by 9 publications

References 9 publications

Coronary Arteriovenous Fistula in a Child Presenting with Chest Pain

Coronary Arteriovenous Fistula in a Child Presenting with Chest Pain

An echolucent structure on the anterolateral wall of the right atrium

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

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