Congenital coronary artery fistulas: clinical considerations and surgical treatment

Hong, Gou-Jieng; Lin, Chih-Yuan; Lee, Chung-Yi; Loh, Shih‐Hurng; Yang, Hou-Sheng; Liu, Kuang‐Yi; Tsai, Yi‐Ting; Tsai, Chien‐Sung

doi:10.1111/j.1445-1433.2004.02980.x

Cited by 41 publications

(50 citation statements)

References 31 publications

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“…The majority of adult patients is to symptoms and usually must be treated surgically or by hemodynamic embolization with disposable balloon. Sternotomy and open heart ligation represent a more common option, sometimes using extracorporeal circulation support in more complex fistulous tracts [1,3,4].…”

Section: Discussionmentioning

confidence: 99%

“…The main referrals for surgical correction are the symptomatic cases, especially heart failure or myocardial ischemia. A previous criterion for the operation is in the presence of shunt (pulmonary blood/ systemic blood -Qp/Qs >2.0) and hemodynamic changes with heart insufficiency symptoms [1,3].…”

Section: Fig 2 -Preoperative and Postoperative Coronariography Of Comentioning

confidence: 99%

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Videotoracoscopia para fechamento de fístula coronário-pulmonar: relato de caso

Júnior¹,

Filho²,

Granzotto³

et al. 2010

Rev Bras Cir Cardiovasc

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The coronary artery fistulas (CAF) are rare and often found occasionally. The conventional treatment can be made by surgical closure with median thoracotomy or with embolization by catheterization. We describe an innovative technique to ligature of CAF, on a full endoscopy. Women, 45 years with symptomatic fistula between coronary artery anterior descending and trunk artery pulmonary, which took thoracoscopy left, pericardiotomy and ligation of fistula with metal clip without thoracotomy. There were no complications, stayed 24 hours in the ICU and was in hospital 4 days. The technique was effective, allows easy surgical accessibility and quick post-operative recovery.Descriptors: Arterio-arterial fistula, surgery. Pulmonary artery, pathology. Coronary vessel anomalies, surgery. Video-assisted surgery. Resumo As fístulas da artéria coronária (FAC) são raras e, muitas vezes, achado ocasional. O tratamento convencional é realizado por fechamento cirúrgico com toracotomia mediana ou por meio de embolização por procedimento hemodinâmico. Descrevemos uma técnica inovadora para ligadura da FAC de forma totalmente endoscópica. Mulher, 45 anos, com fístula sintomática entre artéria coronária descendente anterior e tronco de artéria pulmonar onde se realizou toracoscopia esquerda, pericardiotomia e ligadura do pertuito com clipe metálico. Não houve intercorrência, a paciente permaneceu 24 horas na UTI e teve alta hospitalar no 4º dia. A técnica foi efetiva, permitiu fácil acessibilidade cirúrgica e rápida recuperação pós-operatória.

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Section: Discussionmentioning

confidence: 99%

Section: Fig 2 -Preoperative and Postoperative Coronariography Of Comentioning

confidence: 99%

Videotoracoscopia para fechamento de fístula coronário-pulmonar: relato de caso

Júnior¹,

Filho²,

Granzotto³

et al. 2010

Rev Bras Cir Cardiovasc

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“…In acquired CAF, fistula formation have been associated with an increased expression of some growth factors such as vascular endothelial growth factor, which has the most important role in angiogenesis and vascular migration (11) . The incidence of symptoms and complications increases with age, particularly after the age of 20 (12,13) . The most frequent symptoms of CAF are dyspnea at rest or on exertion, fatigue, and angina (1,14) .…”

Section: Discussionmentioning

confidence: 99%

Coronary Artery Fistula within Large Left Atrial Thrombus in a Patient with Rheumatic Mitral Stenosis: A Case Report and Review

Altıntaş¹,

Altıntaş²,

Baysal³

et al. 2017

Kosuyolu Heart Journal

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Coronary artery fistulae, which are connections between coronary artery branches and cardiac chambers or major vessels, are usually congenital forms of coronary artery anomalies, but rarely may be acquired because of cardiac trauma, neovascularity in association with cardiac neoplasm, mural thrombus formation, or iatrogenic causes. Although half of the patients with coronary artery fistula remain asymptomatic, these fistulae may lead to angina, syncope, congestive heart failure, myocardial infarction, and sudden death. Here we present a case of coronary artery fistula between right coronary artery and left atrium through a large left atrial thrombus in a patient with rheumatic mitral stenosis. The diagnosis was confirmed using echocardiography, conventional and multislice computed tomography, and coronary angiography. To the best of our knowledge, this interesting and unique entity is the first to be reported in the present literature.Key Words: Coronary artery fistula; left atrial thrombus; rheumatic mitral stenosis Romatizmal Mitral Stenozu Olan Hastada Büyük Sol Atriyal Trombüs İçine Doğru Seyreden Koroner Arter Fistülü ÖZETKoroner arter dalları ile kardiyak boşluklar veya büyük damarlar arasındaki normal dışı bağlantılar olan koroner arter fistülleri (KAF) genellikle koroner arter anomalilerinin konjenital formlarıdır. Fakat nadiren kardiyak travma, iyatrojenik nedenler veya kardiyak neoplazm ve mural trombüs oluşumu ile ilişkili neovaskülarizasyona ikincil edinsel olabilir. KAF'ı olan hastaların yaklaşık yarısının asemptomatik kalmasına rağmen bu fistüller anjina, senkop, konjestif kalp yetmezliği, miyokart infarktüsü ve ani ölüme yol açabilirler. Bu yazıda romatizmal mitral kapak stenozu olan bir hastada sağ koroner arter (RCA) ile sol atriyum (LA) arasında, büyük LA trombüs içine açılan KAF'ı sunuyoruz. Tanı 2 boyutlu ekokardiyografi, konvansiyonel koroner anjiyografi ve çok kesitli bilgisayarlı tomografik koroner anjiyografi kullanılarak doğrulandı. Bildiğimiz kadarı ile bu ilginç ve benzersiz durum mevcut literatürde ilk defa raporlanmıştır.

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“…Moreover, recent studies have indicated that intracardiac closure of the distal end of CAFs under CPB reduces the likelihood of residual or recurrent fistulas. 12) On the other hand, transcatheter embolization of a CAF has been recently reported as an alternative to surgical therapy. 3,16,17) Although several complications such as T-wave inversion on an electrogram, embolization of the coil to the pulmonary artery, and transient arrhythmias were experienced in 30% of patients, 3,16) complete closure of CAVF was obtained in 78% to 82% of patients by transcatheter embolization.…”

Section: Discussionmentioning

confidence: 99%

“…However, some studies have emphasized that the incidence of symptoms and complications increases with age, particularly after the age of 20. 11,12) A review of 187 patients has shown that symptoms and fistula-related complications occurred in 55% and 35% of patients over 20 years, respectively, but in 9% and 11% of those under 20 years old.…”

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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Congenital coronary artery fistulas: clinical considerations and surgical treatment

Abstract: Early surgical treatment for coronary artery fistulas is safe and effective. The risk of operative correction appears to be considerably less than the potential for development of serious and potentially fatal complications, even in asymptomatic patients.

Cited by 41 publications

References 31 publications

Videotoracoscopia para fechamento de fístula coronário-pulmonar: relato de caso

Videotoracoscopia para fechamento de fístula coronário-pulmonar: relato de caso

Coronary Artery Fistula within Large Left Atrial Thrombus in a Patient with Rheumatic Mitral Stenosis: A Case Report and Review

Coronary Artery Fistula From the Left Circumflex to the Coronary Sinus

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