Echocardiographic diagnosis of coronary artery fistula in both dizygotic twin brothers

Abstract

A congenital coronary artery fistula (CAF) is a rare form of heart disease in which a coronary artery and a cardiac chamber or another vascular structure communicate. CAF could worsen ventricular perfusion and function, favoring ventricular ischemia and arrhythmias. To our knowledge, this is the first report of CAF, draining in the pulmonary artery, in two asymptomatic dizygotic twin brothers, diagnosed by echocardiography. Dizygotic twins are siblings with different genes exposed to the same environmental experience during the pregnancy. The occurrence of CAF (with similar instrumental findings) in both twin brothers could depend on a poorly identified environmental factor during pregnancy.

Incidental congenital coronary artery vascular fistulas in adults: Evaluation with adenosine-13N-ammonia PET-CT

“…Coronary artery vascular and cameral fistulas are increasingly found during echocardiography[ 3 , 31 , 32 ], CTCA[ 2 , 33 ] and diagnostic CAG procedures[ 1 ]. One study reported the diagnosis of a small coronary-pulmonary fistula (CPF) by echocardiography in asymptomatic dizygotic twin infant brothers[ 31 ], suggesting a possible genetic cause of CAFs.…”

“…Coronary artery vascular and cameral fistulas are increasingly found during echocardiography[ 3 , 31 , 32 ], CTCA[ 2 , 33 ] and diagnostic CAG procedures[ 1 ]. One study reported the diagnosis of a small coronary-pulmonary fistula (CPF) by echocardiography in asymptomatic dizygotic twin infant brothers[ 31 ], suggesting a possible genetic cause of CAFs. Invasive CAG is considered the gold standard for the detection and diagnosis of congenital CAFs; however, non-invasive imaging techniques such as contrast echocardiography[ 34 ], 2D and color Doppler echocardiography, cardiovascular MRI and CTCA provide valuable complementary data for the visualization of fistula components (origin, pathway and termination sites) that are not visible on the CAG[ 20 , 35 - 37 ].…”

Multiple Coronary Artery Microfistulas in a Girl with Kleefstra Syndrome

“…No genetic cause has been so far related to CAFs. There is one report of CAFs in dizygotic twins, but the authors suggested the presence of a poorly identified environmental factor during pregnancy [ 7 ].…”