A rare case of left atrial myxoma vascularity causing acquired coronary cameral fistula: Role of transesophageal echocardiography

Subash, S; Thimmarayappa, Ashwini; Patel, Guru P; Dhananjaya, Manasa; Gopal, Divya; Manjunatha, N

doi:10.4103/heartviews.heartviews_79_17

Cited by 5 publications

(5 citation statements)

References 10 publications

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“…Acquired coronary fistulas may result from MI, hypertrophic cardiomyopathy, dilated cardiomyopathy, tumor, PCI, CABG, cardiac transplant, cardiac biopsy, pacemaker placement, and others ( 12 – 14 ). Microvasculature rupture may be the most important cause of ACFs ( 15 , 16 ).…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Characteristics of Acquired Coronary Fistulas After Successful Revascularization of Chronic Total Occlusion

Fan

Tan

Song

et al. 2021

Front. Cardiovasc. Med.

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Background and Objectives: Acquired coronary fistulas (ACFs) are rare coronary artery abnormalities in patients with chronic total occlusion (CTO). It has been found after revascularization, and it may cause fluster during the CTO percutaneous coronary intervention (CTO PCI). How to distinguish between ACFs and coronary perforation (CP) is very important for CTO operators. Chronic total occlusion reopening may reveal the microchannel of the adventitial vascular layers. Some of ACFs have been seen after revascularization. This study aimed to investigate the characteristics of ACFs after successful CTO PCI.Methods: The clinical and procedural characteristics, medical history, and findings in electrocardiography (ECG), echocardiography, and coronary angiography were collected from 2,169 consecutive patients undergoing CTO PCI between January 2018 and December 2019 and analyzed retrospectively.Results: About 1,844 (85.02%) underwent successful CTO PCI with complete revascularization. Acquired coronary fistulas were found in 49 patients (2.66%): the majority of patients with ACFs were men (81.63 vs. 60.78%; p = 0.016) and younger (62.8 vs. 66.69 years; p = 0.003), and had a history of myocardial infarction (MI) or Q-wave (69.39 vs. 54.21%; p = 0.035); 38 (77.55%) patients had multiple fistulas (≥3), and ACFs affected multiple branches of the CTO vessel (≥3) in 29 (59.18%) patients. None had pericardial effusion, tamponade, and hemodynamic abnormality before or after PCI.Conclusion: Acquired coronary fistulas after successful CTO PCI are mainly present in young and male patients with a history of MI, and they often involve multiple fistulas and distal CTO vessels.

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Section: Discussionmentioning

confidence: 99%

Prevalence and Characteristics of Acquired Coronary Fistulas After Successful Revascularization of Chronic Total Occlusion

Fan

Tan

Song

et al. 2021

Front. Cardiovasc. Med.

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“…ACFs could result from MI, hypertrophic cardiomyopathy, dilated cardiomyopathy, tumor, PCI, CABG, cardiac transplant, cardiac biopsy, and pacemaker placement, among other etiologies [14][15][16]. Rupture of the microvasculature may be the most important cause of ACFs [17,18].…”

Section: Discussionmentioning

confidence: 99%

Dose All of the Coronary Fistulas been Created by the Reopening Wire After Successful Revascularization of Chronic Total Occlusion?

Fan¹,

Tan²,

Song³

et al. 2020

Preprint

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Background: Coronary fistulas may be congenital or acquired generally as consequence of coronary interventions, mainly chronic total occlusion (CTO) reopening. When the reopening wire passes through the occlusion it may microperforate the advential vascular layers, favoring the fistulous communication between coronary vessel and cardiac chambers. But some of acquired coronary fistulas (ACFs) had been already present at the CTO vessels and would been seen after revascularization. This study was designed to investigate the characteristics of ACFs, which albeit mostly benign can cause concern and unnecessary treatment post successful CTO percutaneous coronary intervention (PCI).Methods: Data, including clinical and procedural characteristics, medical history, and findings in electrocardiography, echocardiography and coronary angiography, from 2169 consecutive patients undergoing CTO PCI between January 2018 and December 2019 were analyzed retrospectively. Results: 1844 (85.0%) underwent successful CTO PCI with complete revascularization. Among them, there were 49 cases (mean age, 62.80 ± 11.24 years; 40 men) of ACFs: 24 (49%) involved the right coronary artery, 19 (38.8%) the left anterior descending artery, and 6 (12.2%) the circumflex branch; and 38 (77.6%) were coupled with multiple fistulas (>3), and 29 (59.2%) affected multiple branches of the CTO vessel (>3). The majority of patients with ACFs had a history of MI or Q-wave (n=34, 69.4%), and angina was the most common complaint (n=41, 83.7%). None of them had pericardial effusion, tamponade and Hemodynamic abnormalities before or after PCI.Conclusion: ACFs after successful CTO PCI mostly developed in patients with MI history, originated from the right coronary artery or left anterior descending artery, and involved multiple fistulas and CTO vessel branches.

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“… 2 On review of the published literature, there are only a few reports on the association of coronary-cameral fistulas with left atrial myxomas and intracardiac tumors. 3 , 4 Based on the size of the coronary-cameral fistulas, these may also present with a steal syndrome, myocardial infarction, dyspnea, angina, and congestive heart failure, either alone or in combination. 8 There is currently no published literature that reports coronary-cameral fistulas in conjunction with cardiac melanomas.…”

Section: Dicussionmentioning

confidence: 99%

“… 2 There are reports of coronary-cameral fistulas associated with other cardiac tumors. 3 , 4 Our case is a rare presentation of a metastatic melanoma of the heart with coronary-cameral fistulas, where we discuss the diagnostic pathways and the critical care management of one such patient in our cardiovascular surgery intensive care unit.…”

Section: Introductionmentioning

confidence: 98%

An Incidental Finding of Coronary-cameral Fistulas in a Critically Ill Patient with a Metastatic Cardiac Tumor

Thyagarajan¹,

Bryant²,

Khanna³

2021

Indian Journal of Critical Care Medicine

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A bstract It is extremely rare for a cardiac tumor to present with coronary-cameral fistulas. A 66-year-old Caucasian male presented with worsening dyspnea and subsequently had a cardiac catheterization for an ST-elevation myocardial infarction, revealing no evidence of coronary artery disease but multiple coronary-cameral fistulas. Venoarterial (VA) extracorporeal membrane oxygenation was initiated for a severe cardiogenic shock. Workups including a transesophageal echocardiography and a right heart catheterization led to a diagnosis of metastatic melanoma involving both ventricles of his heart. Angiogenesis is well described in melanomas and our novel case reports the extremely rare association of coronary-cameral fistulas with a metastatic cardiac melanoma. How to cite this article: Thyagarajan B, Bryant C, Khanna AK. An Incidental Finding of Coronary-cameral Fistulas in a Critically Ill Patient with a Metastatic Cardiac Tumor. Indian J Crit Care Med 2021;25(3):340–342.

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A rare case of left atrial myxoma vascularity causing acquired coronary cameral fistula: Role of transesophageal echocardiography

Cited by 5 publications

References 10 publications

Prevalence and Characteristics of Acquired Coronary Fistulas After Successful Revascularization of Chronic Total Occlusion

Prevalence and Characteristics of Acquired Coronary Fistulas After Successful Revascularization of Chronic Total Occlusion

Dose All of the Coronary Fistulas been Created by the Reopening Wire After Successful Revascularization of Chronic Total Occlusion?

An Incidental Finding of Coronary-cameral Fistulas in a Critically Ill Patient with a Metastatic Cardiac Tumor

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