Coronary-Bronchial Artery Fistula Manifested by Hemoptysis and Myocardial Ischemia in a Patient with Bronchiectasis

Abstract

A coronary-bronchial artery fistula is a very rare congenital anomaly of the coronary artery whose etiology and pathogenesis have not yet been clarified. Most patients with coronary-bronchial fistulas are asymptomatic; however, some patients present with congestive heart failure, infective endocarditis, myocardial ischemia induced by a coronary steal phenomenon, or rupture of an aneurysmal fistula. Furthermore, patients with a coronary-bronchial artery fistula rarely manifest life-threatening hemoptysis due to the associated bronchiectasis. We report herein the case of a patient with a coronary-bronchial artery fistula who had bronchiectasis and a history of massive hemoptysis and myocardial ischemia.

Surgical Management of a Coronary-Bronchial Artery Fistula Combined with Myocardial Ischemia Revealed by 13N-Ammonia Positron Emission Tomography

“…They proposed that 2 factors regulate the reopening and growth of arterial communications: disequilibrium of the pressure gradient between the 2 arteries and obstruction of the coronary arteries. Additionally, several case series have implied the possibility of a relationship between coronary-bronchial artery fistula and known bronchiectasis [2,5]. Similar to the patients who have previously been described, our patient also suffered from bronchiectasis.…”

Case Report: A Rare Case of Coronary-Bronchial Fistula Associated with a Large Lung Bullae and Bronchiectasis Presenting as Dyspnea

“…Clinical presentation of patients with CBF depends on the degree of left to right shunt and the concomitant disease process in the patients. Said et al reported that chest pain was the most frequent symptom (63%) that was mainly due to a coronary steal phenomenon [8,10], hemoptysis (26%), Dyspnea (19%). Asymptomatic disease occurred only in (19%) [10].…”

“…Said et al reported that chest pain was the most frequent symptom (63%) that was mainly due to a coronary steal phenomenon [8,10], hemoptysis (26%), Dyspnea (19%). Asymptomatic disease occurred only in (19%) [10]. Our patient was admitted for exertional dyspnea and pleuritic chest pain.…”

Coronary Bronchial Steal

“…A Coronary bronchial artery fistula [CBF] is detected in 0.18% of patients who undergo routine coronary angiography [2]. When the coronary fistula drains into the right side of the heart, the volume load is increased to the right heart as well as to the pulmonary vascular bed, the left atrium, and left ventricle.When the fistula drains into the left atrium or the left ventricle, there is volume overloading of these chambers but no increase in the pulmonary blood flow.…”

“…Several previous reports [2] have proposed that patients with a coronary-bronchial artery fistula need aggressive treatment, including embolization, in order to prevent lethal complications such as aneurismal rupture or infective endocarditis. Some advocate closure of coronary artery fistulae even in asymptomatic patients [4].…”