Coronary Artery Fistula: An Abnormality Affecting All Age Groups

Sapin, Peter M.; Frantz, Elman G.; Jain, Avanindra; Nichols, Timothy C.; Dehmer, Gregory J.

doi:10.1097/00005792-199003000-00004

Cited by 99 publications

(87 citation statements)

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“…Management of asymptomatic patient with insignificant shunts is a matter of debate; however most favor a conservative approach in trivial shunts without any symptoms. [13][14][15][16] Concomitant cardiac diseases are important in the planning the management approach for CPAF. In patients requiring surgical closure of the concomitant cardiac disease, the closure of the CAVFs should be performed to reduce postoperative early and late complications.…”

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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“…[3][4][5] Complications associated with coronary fistulas are heart failure, myocardial ischemia, infective endocarditis, arrhythmias, and rupture. 5 Many coronary fistulas, however, are asymptomatic and are found incidentally.…”

Section: Discussionmentioning

confidence: 99%

A Rare Case of Congenital Coronary Artery Fistula Evaluated by Cardiac MRI

Disawal

2013

Nep J Radiology

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In a patient with coronary artery fistula extending from anterior aortic sinus to posterosuperior wall of right atrium, Magnetic Resonance Imaging was able to accurately demonstrate dilatation of the involved coronary artery, the tortuous nature of the dilated fistula, blood flow within the fistula and its communication with right atrium. Coronary artery fistulas are among the rare anomalies of coronary arteries. Role of angiography is well established in identification and characterization of these anomalies, however their accurate course and termination is often not defined. We demonstrate role of cardiovascular MRI in non-invasively diagnosing and characterizing the course of these anomalous coronary branches. Here we report a rare case of coronary artery fistula, symptomatic due to hemodynamically significant coronary steal phenomenon. Magnetic Resonance Imaging revealed abnormal dilated tortuous channel extending from anterior aortic sinus and posterosuperior wall of right atrium suggestive of right coronary artery fistula. Large opening of the fistula was repaired with SFD patch and opening of the fistula in right atrium was closed directly with prolene.

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“…One of the rare manifestations is endocarditis. 1 Rupture of the CAVF is a rare etiology of cardiac tamponade. Said et al reported that 26% of CAVF showed aneurysmal formation, 7 but spontaneous rupture has been reported in only 3 cases.…”

Section: Discussionmentioning

confidence: 99%

“…Incomplete ablation of the CAVF can occurred in patients with multiple fistulous entry points in the receiving chamber, but in most cases these newly developed CAVFs are hemodynamically insignificant and surgical closure is not required. 1 The most serious complication is myocardial infarction after the repair of a CAVF with a markedly dilated coronary artery and anticoagulation treatment is necessary to prevent this complication. 8,9 …”

Section: Discussionmentioning

confidence: 99%

“…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.…”

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confidence: 99%

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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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Coronary Artery Fistula: An Abnormality Affecting All Age Groups

Cited by 99 publications

References 0 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

A Rare Case of Congenital Coronary Artery Fistula Evaluated by Cardiac MRI

Coronary Arteriovenous Fistula Presenting as Chronic Pericardial Effusion.

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