Left Ventricular to Coronary Sinus Fistula Following Multiple Mitral Valve Replacement Surgeries

Abstract

Development of left ventricular to coronary sinus fistula is a rare complication of mitral valve surgery. Three of the seven previously reported cases occurred following multiple valve replacement surgeries, all of which were thought to be secondary to a complication of surgery and all were treated with surgical closure of the fistula. We report a case of left ventricular to coronary sinus fistula occurring after two mitral valve replacement surgeries that was treated medically with favorable long-term results.

Percutaneous closure of an Iatrogenic fistula from the left ventricle to the coronary sinus

“…Fistulas between the left ventricle and coronary sinus are rare, but have been reported many times in the literature. The first mention was in a case report from 1972, describing a fistula that occurred after mitral valve replacement with a Starr‐Edwards valve , and most reported cases have been subsequent to mitral valve replacement . The proposed mechanisms include a direct stab wound during surgery, or excessive debridement of the posterior wall in the setting of a heavily calcified mitral annulus, which predisposes to spontaneous dissection and eventual fistula formation .…”

“…The first mention was in a case report from 1972, describing a fistula that occurred after mitral valve replacement with a Starr‐Edwards valve , and most reported cases have been subsequent to mitral valve replacement . The proposed mechanisms include a direct stab wound during surgery, or excessive debridement of the posterior wall in the setting of a heavily calcified mitral annulus, which predisposes to spontaneous dissection and eventual fistula formation . Other etiologies have been reported, such as after myocardial infarction and after ventricular tachycardia ablation .…”

“…Typically, left ventricle to coronary sinus fistulas have been treated surgically . However, patients have also been treated conservatively, with medical therapy.…”

“…Fistulas from the left ventricle to the coronary sinus are rare events, and may be congenital or iatrogenic . The first documented iatrogenic case occurred after mitral valve surgery, and most of the reported cases have resulted from mitral valve replacement .…”

“…Fistulas from the left ventricle to the coronary sinus are rare events, and may be congenital or iatrogenic . The first documented iatrogenic case occurred after mitral valve surgery, and most of the reported cases have resulted from mitral valve replacement . Fistulas have also been noted after other procedures involving the inferolateral wall of the left ventricle and have even occurred spontaneously after myocardial infarction .…”