Fistule coronaire : rapport d’un cas opéré et revue de la littérature

Coronary artery to pulmonary artery fistula

“…A fistula between the left anterior descending artery and the main pulmonary artery, as in the case, is a very rare finding [3,7]. The main indications for closure of CAF are clinical symptoms, particularly heart failure and myocardial ischemia and, in asymptomatic patients with high-flow shunting, to prevent occurrence of undesirable complications [2]. Surgical intervention to correct the fistula is recommended for symptomatic patients and for those asymptomatic patients at risk for future complications such as bacterial endocarditis, thrombosis, distal embolization, aneurysm, dissection, rupture, premature atherosclerosis, pulmonary hypertension, myocardial ischemia or infarction [2,8,9].…”

“…Coronary artery fistulae represent the most frequent congenital anomalies of the coronary arteries, but remain a relatively uncommon clinical problem [4]. These fistulas are usually discovered incidentally upon coronary angiography [2,3]. Various symptoms and signs related to the fistula depending on the type of fistula, shunt volume, site of shunt, and presence of other cardiac conditions [1,2].…”

“…These fistulas are usually discovered incidentally upon coronary angiography [2,3]. Various symptoms and signs related to the fistula depending on the type of fistula, shunt volume, site of shunt, and presence of other cardiac conditions [1,2]. The majority of these fistulas are congenital but can nevertheless arise after a cardiac surgery [4].…”

A Rare Case of Left Anterior Descending Coronary Artery to Pulmonary Trunk Fistula Associated with Takotsubo Cardiomyopathy

“…Despite the varieties in clinical features of this rare anomaly, a Takotsubo Cardiomyopathy scenario is rarely a presenting feature or an associated condition. A coronary steal syndrome represents a possible mechanism induced by the fistula, leading to regional wall ischemia and resulting in a TM-like picture [5,[14][15][16][17].…”

“…A coronary steal phenomenon refers to the diversion of blood away from normal myocardial circulation, further leading to (reversible) myocardial ischemia, mimicking a Takotsubo-Cardiomyopathy-like presentation [5,[14][15][16][17]. Additionally, coronary vasospasm and abnormalities in coronary microvascular function and catecholamine-mediated cardiotoxicity, triggered by intense emotional-stress-induced adrenergic drive playing a dominant role in the pathophysiological mechanism [5,[14][15][16][17]. High levels of circulating epinephrine stimulate beta-2-adrenergic-receptors in ventricular myocytes, causing a switch from Gs protein to Gi protein, which further blocks the pro-apoptotic effect of intense beta-1-stimulation.…”