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

Abstract

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.

Incidental Finding

“…Coronary artery fistulas most commonly originate from the right coronary artery but may arise from the left coronary artery, both coronary arteries, or an anomalous single coronary artery. [2][3][4][5] Low pressure chambers are the usual drainage sites as the majority of the CAVFs terminate in the right side of the heart. The physiology of a fistula varies with the chamber and/or vessel in which it terminates.…”

“…[1][2][3] It is reported to occur in only 1 in 50 000 patients with congenital heart disease. 3,4 Congenital coronary arteriovenous fistula is an abnormal connection between one of the coronary arteries and one of the great veins entering the heart, whereas a coronary-cameral fistula involves a connection to a cardiac chamber. [2][3][4] Both of the aforementioned entities, however, are usually referred to as simply coronary arteriovenous fistula (CAVF).…”

“…3,4 Congenital coronary arteriovenous fistula is an abnormal connection between one of the coronary arteries and one of the great veins entering the heart, whereas a coronary-cameral fistula involves a connection to a cardiac chamber. [2][3][4] Both of the aforementioned entities, however, are usually referred to as simply coronary arteriovenous fistula (CAVF). A case is reported in the following of an incidental finding of a congenital coronary-cameral fistula by transthoracic echocardiogram.…”

“…Congenital coronary arteriovenous fistula is a rare anomaly first described by Krause in 1865. [1][2][3] It is reported to occur in only 1 in 50 000 patients with congenital heart disease. 3,4 Congenital coronary arteriovenous fistula is an abnormal connection between one of the coronary arteries and one of the great veins entering the heart, whereas a coronary-cameral fistula involves a connection to a cardiac chamber.…”