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

Abstract

Coronary artery fistula (CAF) is an anomalous connection between a coronary artery and a major vessel or cardiac chamber. Most of the coronary fistulas are discovered incidentally during angiographic evaluation for coronary vascular disorder. The management of CAF is complicated and recommendations are based on anecdotal cases or very small retrospective series. We present three cases of CAF, two of which were symptomatic due to hemodynamically significant coronary steal phenomenon. They underwent successful transcatheter coil embolization, leading to resolution of their symptoms. Percutaneous closure offers a safe and effective way for the management of symptomatic patients. CAFs are rare cardiac anomalies but can give rise to a variety of symptoms because of their hemodynamic consequences or complications. They should be part of cardiac differential diagnosis particularly in patients without other risk factors. Correction of CAF is indicated if the patients are symptomatic or if other secondary complications develop.

Multiple left anterior descending coronary artery to left ventricular fistula – A case series and literature review

“…due to chest trauma or iatrogenic causes. Twenty percent of people with congenital CAFs have other concomitant cardiac anomalies, such as aortic and pulmonary atresia and patent ductus arteriosus [2]. …”

“…Angiography helps define the artery of origin, recipient vessel, or chamber and the site of communication. Noninvasive techniques such as transthoracic echocardiography, transesophageal echocardiography and magnetic resonance imaging are becoming increasingly popular for diagnosis and follow-up of CAFs [2]. Combined two-dimensional and pulsed Doppler echocardiography demonstrates a dilated coronary artery, turbulent flow in the fistula and the recipient chamber.…”

“…They are reported very rarely in the adults. Coronary artery fistulas are defined as single or multiple, small or large direct communications that arise from one or more coronary arteries and enter into one of the four cardiac chambers or major vessels [2]. They may be congenital or acquired, associated with various disorders or spontaneous.…”

Coronary artery fistulas: A case presentation and literature review

“…Raju et al stated that various patient factors contribute to development of symptoms including age, amount of shunting and development of ischemia. The most common symptom from these fistulae is chest pain attributed to coronary steal [9] . Coronary artery fistulae can become quite impressive with the largest one documented by Gupta et al [3] .…”

Successful Percutaneous Coil Embolization of a Large and Tortuous Coronary Artery to Pulmonary Artery Fistula

“…Coronary artery fistulas can result in heart failure (4-7), myocardial ischemia (4,6,(8)(9)(10), endocarditis (11) and rupture of aneurysmal vessels (12)(13)(14). The majority of coronary artery fistulas originate from the right coronary artery or left anterior descending artery (LAD) and connect with a pulmonary artery, pulmonary vein, cardiac chamber, coronary sinus or the vena cava (15)(16)(17). Symptomatic coronary artery fistulas should be treated with percutaneous intervention or surgery (4,10,15,(18)(19)(20).…”