Right Coronary Artery Fistula to Left Ventricle Treated by Transcatheter Coil Embolization: A Case Report and Literature Review

Abstract

A coronary artery fistula between a coronary artery and a cardiac chamber is a rare condition. We reported a case of right coronary artery fistula to the left ventricle in a 57-year-old man who had 2-year history of chest pain and exercise dyspnea without significant coronary atherosclerosis with abnormal left ventricular size and function. It was important to recognize this anomaly and our experience showed that transcatheter occlusion of coronary artery fistula was a safe and effective procedure in the presence of symptoms of congestive heart failure, significant left-to-right shunt or refractory to medical treatment.

Successful Percutaneous Coil Embolization of a Large and Tortuous Coronary Artery to Pulmonary Artery Fistula

“…Successful transcatheter closure of a coronary artery fistula was first reported in 1983 (21). Since then, this treatment method has become more popular and is now widely avail- able (6,7,9,(18)(19)(20). Because of the low prevalence of coronary artery fistulas, the optimal management remains unclear and there are no established therapeutic guidelines.…”

“…Because of the low prevalence of coronary artery fistulas, the optimal management remains unclear and there are no established therapeutic guidelines. Treatment with percutaneous intervention or surgery is recommended for patients with symptoms such as chest pain and dyspnea (4,10,15,(18)(19)(20) and to prevent the development of heart failure (4-7), myocardial ischemia (4, 6, 8-10), endocarditis (11) or rupture of aneurysmal vessels (12)(13)(14). Cebi et al indicated that symptomatic coronary artery fistulas should be closed irrespective of the size of the left-to-right shunt (4).…”

“…In this case, we successfully performed percutaneous coil embolization even though the fistula was large and tortuous. Recent improvements in endovascular techniques and devices have resulted in the increased use of percutaneous intervention for the noninvasive treatment of coronary artery fistulas (6,7,9,(18)(19)(20).…”

“…The majority of coronary artery fistulas originate from the right coronary artery or left anterior descending artery (LAD) and connect with a pulmonary artery, pulmonary vein, cardiac chamber, coronary sinus or the vena cava (15)(16)(17). Symptomatic coronary artery fistulas should be treated with percutaneous intervention or surgery (4,10,15,(18)(19)(20). We herein report a case of successful percutaneous coil embolization of a large and anatomically complex coronary artery to pulmonary artery fistula.…”

Coronary-to-bronchial artery fistula in a patient with angina

“…Clinical presentations are variable depending on the type of fistula, shunt volume, site of the shunt, and presence of concomitant cardiac abnormalities. Diagnosis is often occasional in adulthood because clinical presentation, laboratory, and electrocardiographic manifestations are nonspecific [1,2,6]. Angina and/or dyspnea are the most common symptoms and seem to be related to the coronary steal phenomenon [7].…”