Congenital coronary arteriovenous fistula: Spontaneous rupture and cardiac tamponade

Bauer, Hans H.; Allmendinger, Philip D.; Flaherty, James; Owlia, Dariush; Rossi, Michael; Chen, Chunguang

doi:10.1016/0003-4975(96)00757-6

Cited by 93 publications

(71 citation statements)

References 7 publications

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“…In rare cases, CPAF may present with spontaneous rupture leading to hemopericardium and cardiac tamponade. [11] Electrocardiogram and chest xray does not yield much information to aid in diagnosis and may show non specific changes. Angiography remains the gold standard for diagnosing CPAF which can delinate the origin,course,termination of vessels as well as associated anamolies; however use of non-invasive procedures is increasingly becoming popular.…”

Section: Discussionmentioning

confidence: 99%

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

Shah¹,

Kamath

2016

Int J of Biomed & Adv Res

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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.

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Section: Discussionmentioning

confidence: 99%

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

Shah¹,

Kamath

2016

Int J of Biomed & Adv Res

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“…11) Besides these major complications, rupture of coronary artery aneurysms, a very rare but life-threatening complication of CAF, has also been reported in several cases. [13][14][15] Based on these reports, it is recommended that most patients with CAF should be treated prior to the development of symptoms and major pathological changes in the heart, coronary arteries, and pulmonary circulation. Since the first successful ligation of a CAF, several techniques, such as direct proximal and distal ligation, tangential arteriorrhaphy without CPB, direct intracardiac closure of CAFs with CPB, and transcatheter embolization, have been proposed for eliminating these defects while preserving coronary blood flow.…”

Section: Discussionmentioning

confidence: 99%

Coronary Artery Fistula From the Left Circumflex to the Coronary Sinus

et al. 2006

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SUMMARYA 27-year-old woman, who had received mitral valve repair for mitral regurgitation resulting from infective endocarditis, was admitted for a close examination of abnormal echocardiographic findings in the left atrium. Transthoracic echocardiography showed trivial mitral regurgitation with normal left ventricular contraction and dilatation of the coronary sinus. Auscultation revealed a grade 2 continuous murmur along the left sternal border. Transesophageal echocardiography demonstrated a marked dilatation of the coronary sinus just behind the posterior wall of the left atrium and turbulent blood flow in the dilated coronary sinus. Cardiac catheterization showed no significant step-up of oxygen saturation in the right heart and normal pulmonary artery pressure. Coronary angiography revealed a markedly dilated and tortuous circumflex coronary artery connected to the coronary sinus through a fistula. A left circumflex artery with a fistulous connection to the coronary sinus is extremely rare. (Int Heart J 2006; 47: 147-152) Key words: Coronary artery fistula, Coronary artery aneurysm, Circumflex coronary artery, Coronary sinus CORONARY artery fistula (CAF) is a rare congenital anomaly with a reported incidence of 0.1% to 0.2% in the adult population referred for cardiac catheterization.1) Fistulous connection into a cardiac chamber or major vessel often causes a marked dilation of the donor coronary artery leading to aneurysm formation. 2)Among various coronary artery anomalies, fistulous connection of the aneurysmal circumflex coronary artery to the coronary sinus has been previously reported as an extremely uncommon form. [3][4][5][6][7][8] In this paper, we describe a case of an aneurysmal circumflex artery connecting to the coronary sinus through a fistula, and discuss surgical management for patients with CAF, particularly for asymptomatic patients with a small left-toright shunt.From the

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“…Said et al reported that 26% of CAVF showed aneurysmal formation, 7 but spontaneous rupture has been reported in only 3 cases. [4][5][6] Habermann et al reported an autopsy case of sudden death caused by rupture of the CAVF 4 and the other 2 cases had a sudden onset of cardiac tamponade, caused by rupture of a CAVF, and the correct diagnosis was only possible after emergency surgery. 5,6 In those cases, severe atherosclerosis and thrombus formation were found in the resected, ruptured CAVF.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] However, cases with pericardial effusion (PE) caused by rupture of the aneurysmal coronary artery are quite rare; only 3 cases of cardiac tamponade caused by rupture of the CAVF have been previously reported. [4][5][6] We report a case of chronic PE caused by a CAVF. The PE was observed for 6 months, and finally developed into cardiac tamponade.…”

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confidence: 99%

Coronary Arteriovenous Fistula Presenting as Chronic Pericardial Effusion.

Ozeki¹,

Utsunomiya²,

Kishi³

et al. 2002

Circ J

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oronary arteriovenous fistula (CAVF) is an abnormal communication between a coronary artery and a cardiac chamber, great vessel, or other vascular structure. Most of them are found incidentally during coronary angiography (CAG), and are identified as a cause of a continuous murmur, myocardial ischemia, congestive heart failure or, rarely, bacterial endocarditis. [1][2][3] However, cases with pericardial effusion (PE) caused by rupture of the aneurysmal coronary artery are quite rare; only 3 cases of cardiac tamponade caused by rupture of the CAVF have been previously reported. [4][5][6] We report a case of chronic PE caused by a CAVF. The PE was observed for 6 months, and finally developed into cardiac tamponade. Case ReportA 75-year-old woman was referred to hospital for investigation of recurrent PE. She had a history of pulmonary tuberculosis 50 years ago. In August 1998, she had been admitted to another hospital for further investigation of cardiomegaly (cardiothoracic ratio (CTR) 63%) and was the PE was diagnosed for the first time. However, she was free of symptoms and the laboratory examinations were normal, including thyroid function and tuberculin reaction. Chest computed tomography (CT) did not show any abnormal findings except for the PE and a scar from the pulmonary tuberculosis. She was treated with diuretics and the PE disappeared within 6 months. The CTR decreased Circulation Journal Vol.66, August 2002from 63% to 54% on the chest X-ray. In February 1999, she developed shortness of breath and general fatigue, and echocardiographic examination revealed that the PE had recurred.On the admission to hospital in February 1999, her vital signs were: blood pressure 148/70 mmHg, heart rate 92 beats/min, respiratory rate 20 breaths/min, and body temperature 36.5°C. Pulsus paradoxus was not detected. Chest auscultation revealed bilaterally normal respiratory sounds and a soft continuous murmur at the left sternal border of the 4th intercostal space. She had hepatomegaly, bilateral leg edema and a markedly expanded external jugular vein.Laboratory tests were as follows: leukocytes 7.2×10 3 / l; C-reactive protein 0.5 mg/dl; erythrocyte sedimentation rate of 24 mm/h; TSH 1.86 IU/ml; free T3 1.77 pg/ml; free T4 0.83 ng/ml; tuberculin reaction 10×10 mm. A chest Xray revealed cardiomegaly (CTR = 67%) without pulmonary infiltration. The electrocardiogram (ECG) on admission was normal except for flat T waves in leads V4-6 (Fig 1A). An enhanced CT scan revealed a dilated right coronary artery (RCA) and a dilated coronary sinus (CS) vein, an expanded inferior vena cava and a large, circumferential PE (Fig 2). However, leakage of contrast media into the pericardial space was not seen. A diagnostic pericardiocentesis yielded 20 ml of bloody fluid (Hct = 22%) that contained 5.7 mg/dl of protein, 56 mg/dl of glucose and 23.2 IU/L of adenosine deaminase. The culture for bacteria in the pericardial fluid was negative, and a polymerase chain reaction for the tuberculosis bacillus was not detected. There was no evidence of ...

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Congenital coronary arteriovenous fistula: Spontaneous rupture and cardiac tamponade

Cited by 93 publications

References 7 publications

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

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

Coronary Artery Fistula From the Left Circumflex to the Coronary Sinus

Coronary Arteriovenous Fistula Presenting as Chronic Pericardial Effusion.

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