Coronary artery to pulmonary artery fistula with dual origin — embryological, clinical and surgical significance

Vaidyanathan, Karthik; Theodore, Sanjay; Sankar, Madhu N; Cherian, Kotturathu Mammen

doi:10.1016/j.ejcts.2006.11.018

Cited by 25 publications

(28 citation statements)

References 5 publications

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“…With these advanced diagnostic techniques many unilateral [10][11][12][13][14][15] , bilateral [16][17][18][19][20] and multilateral [21] fistulas have been diagnosed. Many reports from various parts of the world recording congenital CAFs in adults have been published during the last decade [22][23][24][25][26][27][28] .…”

Section: Introductionmentioning

confidence: 99%

Current characteristics of congenital coronary artery fistulas in adults: A decade of global experience

Saïd

2011

WJC

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AIM:To describe the characteristics of coronary artery fistulas (CAFs) in adults, including donor vessels and whether termination was cameral or vascular. METHODS:A PubMed search was performed for articles between 2000 and 2010 to describe the current characteristics of congenital CAFs in adults. A group of 304 adults was collected. Clinical data, presentations, diagnostic modalities, angiographic fistula findings and treatment strategies were gathered and analyzed. With regard to CAF origin, the subjects were tabulated into unilateral, bilateral or multilateral fistulas and compared. The group was stratified into two major subsets according to the mode of termination; coronary-cameral fistulas (CCFs) and coronary-vascular fistulas (CVFs). A comparison was made between the two subsets. Fistula-related major complications [aneurysm formation, infective endocarditis (IE), myocardial infarction (MI), rupture, pericardial effusion (PE) and tamponade] were described. Coronary artery-ventricular multiple micro-fistulas and acquired CAFs were excluded as well as anomalous origin of the coronary arteries from the pulmonary artery (PA). RESULTS:A total of 304 adult subjects (47% male) with congenital CAFs were included. The mean age was 51.4 years (range, 18-86 years), with 20% older than 65 years of age. Dyspnea (31%), chest pain (23%) and angina pectoris (21%) were the prevalent clinical presentations. Continuous cardiac murmur was heard in 82% of the subjects. Of the applied diagnostic modalities, chest X-ray showed an abnormal shadow in 4% of the subjects. The cornerstone in establishing the diagnosis was echocardiography (68%), and conventional contrast coronary angiography (97%). However, multislice detector computed tomography was performed in 16%. The unilateral fistula originated from the left in 69% and from the right coronary artery in 31% of the subjects. Most patients (80%) had unilateral fistulas, 18% presented with bilateral fistulas and 2% with multilateral fistulas. Termination into the PA was reported in unilateral (44%), bilateral (73%) and multilateral (75%) fistulas. Fistulas with multiple origins (bilateral and multilateral) terminated more frequently into the PA (29%) than into other sites (10.6%) (P = 0.000). Aneurysmal formation was found in 14% of all subjects. Spontaneous rupture, PE and tamponade were reported in 2% of all subjects. In CCFs, the mean age was 46.2 years whereas in CVFs mean age was 55.6 years (P = 0.003). IE (4%) was exclusively associated with CCFs, while MI (2%) was only found in subjects with CVFs. Surgical ligation was frequently chosen for unilateral (57%), bilateral (51%) and multilateral fistulas (66%), but percutaneous therapeutic embolization (PTE) was increasingly reported (23%, 17% and 17%, respectively). CONCLUSION:Congenital CAFs are currently detected in elderly patients. Bilateral fistulas are more frequently reported and PTE is more frequently applied as a therapeutic strategy in adults.

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Section: Introductionmentioning

confidence: 99%

Current characteristics of congenital coronary artery fistulas in adults: A decade of global experience

Saïd

2011

WJC

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“…Coronary-topulmonary artery fistula (CPAF) is a subtype of CAF in which a coronary artery communicates with a pulmonary artery; this can be congenital in origin or acquired (1). Although most patients with CPAFs are asymptomatic and these fistulas are incidentally detected (2), some of these anomalies may cause dyspnea, chest pain, or even sudden death (3).…”

Section: Introductionmentioning

confidence: 99%

Multi-Detector CT Coronary Angiographic Findings of Coronary-to-Pulmonary Artery Fistula

Bae

Park

Lim

et al. 2017

J Korean Soc Radiol

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Purpose: To evaluate multi-detector CT (MDCT) coronary angiographic findings of coronary-to-pulmonary artery fistula (CPAF). Materials and Methods:We retrospectively reviewed images of patients with CPAF from the coronary CT angiography (CCTA) database obtained with a 64-channel MDCT between January 2008 and March 2011. We analyzed the CCTA findings for feeding arteries, fistula, association with peripulmonary arterial aneurysms, and the presence of communication between the CPAF and bronchial arteries. Results: Fifty-five of the 15042 (0.37%) patients were diagnosed with CPAFs. The feeding artery was single (n = 18) or multiple (n = 37). The fistula had a single drainage site (n = 54) or multiple drainage sites (n = 1). The mean diameter of the fistulous opening was 2.7 ± 1.4 mm. A peripulmonary arterial aneurysm was present in 24 (44%) patients. Communication between CPAF and bronchial arteries was present in eight (14.5%) patients. Conclusion: MDCT coronary angiography can provide comprehensive morphologic details on CPAF and may help in presurgical or preinterventional planning.

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“…Vaidyanathan et al [6] reported a similar coronary artery fistula with a dual origin. Concomitant pathologies may also present with fistula.…”

Section: Resultsmentioning

confidence: 96%

Urgent coronary artery bypass graft operation of a patient with acute anterior myocardial infarction, congenital right coronary artery to main pulmonary artery fistula and left hilar hamartoma of the lung

et al. 2011

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Urgent coronary artery bypass graft operation of a patient with acute anterior myocardial infarction, congenital right coronary artery to main pulmonary artery fistula and left hilar hamartoma of the lung Summary. Background: Coronary artery fistulas are rare congenital or acquired coronary artery anomalies that can originate from any of the three major coronary arteries and drain into all the cardiac chambers and great vessels.Methods (case report): A 67-year-old male patient administered to the emergency department with a severe unstable angina pectoris. Patient underwent a three-vessel coronary artery bypass graft surgery, liga-clip occlusion of coronary artery to pulmonary artery fistula and a direct diagnostic punch biopsy from the left hilar mass lesion.Results: No complications were encountered postoperatively. The patient was discharged on postoperative day eleven with a referral to the thoracic surgery department for further treatment of his lung tumor.Conclusions: In this report we present successful combination of an urgent coronary artery bypass graft operation in acute anterior myocardial infarction status with concomitant pathologies of congenital right coronary artery to main pulmonary artery fistula and left hilar mass lesion of the lung.

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Coronary artery to pulmonary artery fistula with dual origin — embryological, clinical and surgical significance

Cited by 25 publications

References 5 publications

Current characteristics of congenital coronary artery fistulas in adults: A decade of global experience

Current characteristics of congenital coronary artery fistulas in adults: A decade of global experience

Multi-Detector CT Coronary Angiographic Findings of Coronary-to-Pulmonary Artery Fistula

Urgent coronary artery bypass graft operation of a patient with acute anterior myocardial infarction, congenital right coronary artery to main pulmonary artery fistula and left hilar hamartoma of the lung

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