Diagnosis and Surgical Correction of Congenital Coronary Artery-Coronary Sinus Fistula

Ja, Haller; Ja, Little

doi:10.1161/01.cir.27.5.939

Cited by 32 publications

(16 citation statements)

References 7 publications

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“…Haller and Little [12] described the diagnostic triad for coronary artery fistulas: an abnormal localization for a to-and-fro murmur thought to be due to a patent ductus arteriosus; a left to right shunt at the atrial or ventricular level; and a large, tortuous coronary artery at coronary angiography. Bjork and Crafoord reported the first successful fully corrected coronary artery fistulas in 1947 [13].…”

Section: Historical Perspectivementioning

confidence: 99%

Coronary artery fistulas: Clinical and therapeutic considerations

Gowda¹,

Vasavada²,

Khan³

2006

International Journal of Cardiology

347

379

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Section: Historical Perspectivementioning

confidence: 99%

Coronary artery fistulas: Clinical and therapeutic considerations

Gowda¹,

Vasavada²,

Khan³

2006

International Journal of Cardiology

347

379

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“…One post-operative death occurred in a child with a persistent ductus arteriosus and a coronary artery fistula, one patient had no benefit from the operation, and the rest were definitely improved. Later publications, including our own, provide a record of a further 16 patients operated on with good results (Abbott et al, 1961 ;Braudo et al, 1962;Carmichael and Davidson, 1961;Cooley and Ellis, 1962;Haller and Little, 1963;Murray, 1963;Sabiston et al, 1963). One patient died following 'banding' of the pulmonary artery as a ventricular septal defect was suspected (Newcombe et al, 1964).…”

Section: Discussionmentioning

confidence: 91%

“…Upshaw (1962) collected 73 cases published before 1962 and classified them according to origin and drainage area. Later publications have added 22 more cases, making a total of 98 including ours (Abbott, Rivarola, and Logue, 1961 ;Braudo, Javett, Zion, and Adler, 1962;Carmichael and Davidson, 1961;Cooley and Ellis, 1962;Haller and Little, 1963;Honey, 1964;Murray, 1963;Newcombe, Whitaker, and Keates, 1964;Sabiston, Ross, Criley, Gaertner, Neill, and Taussig, 1963 The physiological effect of a coronary artery fistula depends on the shunted volume and the recipient area, while minor variations in the point of origin are probably of less importance.…”

Section: Discussionmentioning

confidence: 99%

Congenital coronary artery fistula.

Dedichen¹,

Skalleberg²,

Cappelen³

1966

Thorax

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Coronary artery fistulae are anomalies characterized by one or more abnormal communications between the coronary arteries and another part of the circulatory system. Haemodynamically they function as arteriovenous shunts, causing blood to bypass the capillary bed. Most of them are not, however, genuine arteriovenous communications in the strict sense of the term, since they empty into a heart chamber or into the pulmonary artery.The anomaly is rare. So far only about 100 cases have been described. The aetiology, physiology, and anatomical variations are reviewed in recent publications by Gasul, Arcilla, Fell, Lynfield, Bicoff, and Luan (1960) and Upshaw (1962). The condition has lately become of increasing interest since it can be diagnosed by cardiac catheterization and coronary angiography, and most cases are amenable to surgical treatment at an acceptable risk.This paper reports three cases with some remarks on the physiology of the condition and its treatment. CASE REPORTS CASE 1 M. P., a 44-year-old woman, was admitted in 1957. From the age of 20 she had been troubled by palpitations and dyspnoea on exercise. For the last six months she had had increasing dyspnoea and retrosternal pain. The heart action was regular but there were some extrasystoles. Blood pressure was 140/90 mm. Hg. A high-frequency, continuous murmur was heard over the heart, maximal at the left lower sternal border. The E.C.G. was normal and radiographic examination revealed a relative heart volume of 390 ml./m.2 and some enlargement of the right atrium and ventricle. Right heart catheterization showed normal pressures in the right heart and pulmonary artery. A left-to-right shunt to the pulmonary artery was demonstrated and calculated to 2-9 I./min., or 38-6% of the total pulmonary flow of 7.5 1./min. At thoracotomy a plexus of vessels was found to connect the right coronary artery and the pulmonary artery (Fig. 1). A thrill was felt in the area. The plexus was temporarily clamped without a change in the heart rhythm or the E.C.G. The fistulous plexus was closed with multiple ligatures both at its coronary origin and close to the pulmonary artery. The thrill disappeared but the heart rhythm and E.C.G. remained unchanged. The post-operative course was uneventful. On examination three months later the patient had no dyspnoea, palpitations, or precordial pain. The E.C.G. was normal. A faint systolic as well as a faint diastolic murmur (but no continuous murmur) were heard over the heart. From 1959 on she again developed dyspnoea and anginal pain on exertion, but the symptoms were moderate and progressed very little during the following years. On admission in 1965 the heart action was regular. Blood pressure was 145/95 mm. Hg. A high-frequency, continuous murmur of moderate intensity was again heard at the left sternal border. An apical systolic murmur was also audible. The E.C.G. showed a digitalis effect but was otherwise normal. On radiological examination the heart contours were normal and the relative heart volume was calculated to 450...

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“…Several treatment options have been described with variable outcomes from coil embolization, occluder device deployment, to surgical ligation [8], depending on the anatomy favoring different interventions. Our patient was offered cardiac catheterization with possible utilization of percutaneous or surgical options depending on suitability of device deployment during the evaluation, but she declined invasive intervention at this time due to her limited life-style and the success of medical therapy in controlling her symptoms.…”

Section: Discussionmentioning

confidence: 99%

Anomalous left anterior descending artery to coronary sinus fistula with associated localized ischemia: A clinical dilemma

2014

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Patient: Female, 57Final Diagnosis: Coronary sinus – venous fistulaSymptoms: DispnoeaMedication: —Clinical Procedure: —Specialty: CardiologyObjective:Rare diseaseBackground:Coronary arterial fistula, or arteriovenous malformation (AVM), is a connection between the coronary tree and a cardiac chamber or great vessel, having bypassed the myocardial capillary bed. Known complications from coronary artery fistulas may include “steal” from the adjacent myocardium, resulting in myocardial ischemia.Case Report:We report the case of a 57-year-old Hispanic woman with abnormal preoperative electrocardiogram (ECG) and symptoms of dyspnea on exertion, who underwent a stress echocardiography demonstrating inferior distribution hypokinesis at peak exercise. Coronary computed tomography angiography (CCTA) demonstrated a venous fistula connecting the coronary sinus (CS) with the distal portion of the left anterior descending artery (LAD), occupying the territory of a left posterior descending artery (L-PDA) and corresponding in distribution with the patient’s stress-induced wall motion abnormalities.Conclusions:Anomalous left anterior descending artery to coronary sinus fistula with associated ischemia is a rare clinical dilemma with limited experience of success with either surgical or medical options.

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Diagnosis and Surgical Correction of Congenital Coronary Artery-Coronary Sinus Fistula

Abstract: Congenital coronary arteriovenous fistula is easily confused with patent ductus arteriosus. An illustrative case is presented which emphasizes the special tests that are necessary to establish the diagnosis. Finally, the successful surgical correction of this abnormality is described.

Cited by 32 publications

References 7 publications

Coronary artery fistulas: Clinical and therapeutic considerations

Coronary artery fistulas: Clinical and therapeutic considerations

Congenital coronary artery fistula.

Anomalous left anterior descending artery to coronary sinus fistula with associated localized ischemia: A clinical dilemma

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