Coronary Artery-Left Ventricular Fistula

Abstract

Coronary artery-left ventricular fistulae are exceedingly rare and to date only 19 cases have been reported in the literature. We describe another four cases which we encountered recently. The first patient was a 10-year-old asymptomatic Indian male who was referred because of a to-and-fro murmur. Haemodynamic and angiographic studies revealed an aneurysmally enlarged right coronary artery draining into the left ventricle. The fistula was ligated and the patient has remained well over a 2½-year follow-up period. The second patient was a 13-year-old asymptomatic Chinese female referred also because of a to-and-fro murmur. Haemodynamic and angiographic studies showed a grossly enlarged right coronary artery draining into the left ventricle. This patient refused operation and has remained well over a 2-year follow-up period. The third patient was a 43-year-old Chinese male who presented with a 3-year history of angina pectoris and was admitted to hospital because of crescendo angina. The resting electrocardiogram showed marked ischaemic changes and the treadmill exercise stress test was also positive. Selective coronary angiography showed markedly dilated right and left coronary arteries. Multiple fistulae from the three major coronary arteries were seen to communicate with the left ventricle. It was elected to treat this patient medically with propranolol. He has remained well over a 6-month follow-up period. The fourth patient was a 5-year-old asymptomatic Chinese girl. Cardiac catheterization and selective coronary angiography revealed marked dilatation of the branches of the left coronary artery which communicated via a maize of fine vessels into the left ventricle. This patient has remained well over a 5-year follow-up period. The clinical presentation, investigations and treatment of coronary artery-left ventricular fistula are discussed and the literature regarding this subject is reviewed.

Coronary artery fistulae: a 10-year review

“…18 Angina pectoris is quite rare in the absence of arteriosclerotic coronary artery disease. 6 Life expectancy is normal in most cases.…”

A Huge Coronary Aneurysm Resulting from a Coronary Artery-to-Left Ventricle Fistula.

“…Hobbs et al (3) reported that a coronary cardiac chamber fistula was detected in 101 (0.2%) of 55,856 patients undergoing coronary angiograms and ony 21 (17.2%) of these fistulae drained into the left ventricle, but none of those patients had a coronary aneurysm. A coronary artery-to-left ventricle fistula with a coronary aneurysm has been reported by only a limited number of investigators (12,13). Edwards (14) described that under the coronary artery-tocardiac chamberfistula, there is torturous milieu and dilatation ofa portion of the coronary arterial system (which forms part of the abnormal communication) leading to generalized dilatation, occasionally being complicated by a localized saccular aneurysm.…”

Myocardial ischemia and infarction due to multiple coronary-cameral fistulae: Two case reports and review of the literature

“…Each of our patients under discussion displays the relatively rare pattern of multiple coronary fistulae draining into the left ventricle. A total of 21 such cases has been reported previously in the literature [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23].…”

“…Most patients are asymptomatic [1,2] and the fistulae are coincidentally identified. However, in patients with plexiform fistula drainage, anginal symptoms have frequently been described [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]. The presumed mechanism is a coronary ''steal'' phenomenon in which the fistula produces a shunt of blood flow away from the coronary artery runoff.…”