Congenital coronary artery-to-pulmonary fistula with giant aneurysmal dilatation and thrombus formation: a case report and review of literature

Abstract

Background Coronary artery-to-pulmonary artery fistula is a rare disorder characterized by abnormal vascular communication between the coronary artery and pulmonary artery. While most patients remain asymptomatic, some might exhibit symptoms of myocardial ischemia, congestive heart failure, or even sudden cardiac death if coronary aneurysm, thrombosis, infective carditis, or other congenital cardiac defects coexist. Case presentation We present a 66-year-old male complaining of angina pectoris with a history of hypertension and active smoking. He was diagnosed with a coronary aneurysm based on coronary computed tomography angiography. We subsequently identified a coronary artery-to-pulmonary artery fistula with giant aneurysmal dilation on coronary angiography. Ultimately we conducted surgery ligation and aneurysmorrhaphy. During surgery, we discovered newly formed thrombus within the aneurysmal cavity. Histological analysis of the aneurysmal wall supported the diagnosis of the congenital disorder. Our patient was successfully discharged and remained asymptomatic at two months of follow-up. Conclusion We presented a rare and complex combination of congenital coronary artery-to pulmonary artery fistula, giant coronary aneurysmal dilatation, and thrombosis through multi-modality evaluations.

Giant Coronary-Pulmonary Artery Fistula Incidentally Detected in a Patient Presenting With Acute Inferior Myocardial Infarction

“…In addition to aneurysm size, female gender, saccular aneurysms, and aneurysmal fistulas originating from the left coronary artery are risk factors for coronary artery aneurysm rupture. Surgical ligation can be performed on large aneurysms [ 16 ]. The risk factors were present in our patient, but no rupture was detected.…”

Prevalence and Clinical Significance of Heart Murmurs Detected on Cardiac Auscultation in 856 Cats

“…Heart murmur in coronary artery to pulmonary artery fistula was associated with a continuous left-to-right blood flow turbulence across the abnormal vascular communication [ 30 ].…”

A Rare Association in Coronary Artery Fıstula: Vieussens Arterial Ring

“…9 Semptomatik koroner ve pulmoner arter arasındaki fistülü olan hastaların tedavisinde oral antikoagülan tedavi, girişimsel endovasküler prosedürler ve cerrahi ligasyon hastaya uygunluğuna göre değerlendirilebilir. 2 Bizim vaka sunumumuzun amacı birlikte nadir gözlenen iki anomalinin özelliklerini ve birlikteliğini ortaya koymaktır. Sonuç olarak Vieussens arteryal halka ve pulmoner fistül birlikteliği nadir gözlenmekle birlikle çeşitli kardiyak semptomlara neden olabilir ve tanı konulmasının ardından birçok parametre göz önüne alınarak tedavi prensibi belirlenir.…”

“…Kalp yetmezliği ve miyokard iskemisi gibi klinik semptom ortaya çıktığında veya asemptomatik bir hastada yüksek akışlı fistül varlığı olduğunda perkütan yada cerrahi müdahale endikedir. 2 Vieussens halkası, ilerlemiş koroner arter hastalığında interkoroner kollateral damar olması sebebi ile klinik önem kazanan embriyolojik bir kalıntıdır. 3 Vieussens arterial halka sağ koroner arter ve sol koroner arter arasında kollateral dolaşım olması durumudur.…”