Spontaneous near closure of coronary artery fistula.

Shubrooks, Samuel J.; Naggar, Charles Z.

doi:10.1161/01.cir.57.1.197

Cited by 32 publications

(8 citation statements)

References 22 publications

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“…[8][9][10] In this case, progressive dilatation of the aneurysm to a diameter exceeding 5 cm suggested that the possibility of acute rupture was an indication for surgical resection, despite the small shunt ratio …”

Section: Discussionmentioning

confidence: 99%

Huge Saccular Aneurysm in a Coronary-Pulmonary Fistula Fed by the Left and Right Coronary Arteries.

Hirooka

Hanatani²,

Nakatani³

et al. 2002

Circ J

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ecause a communication between the coronary arteries and the cardiac chamber or the pulmonary trunk is not a common anomaly, 1 the formation of an aneurysm in this communication vessel is clinically few. [2][3][4] We report an adult case of a huge aneurysm that was fed by both the left anterior descending and the right coronary artery draining anomalously into the main pulmonary artery. Case ReportA 62-year-old woman was referred to hospital because of an abnormal mediastinal shadow on chest roentgenogram. She had been pointed out a heart murmur 30 years ago, but did not have further examinations because she did not have any symptoms. An abnormal shadow on the left cardiac border was first noted on plain chest roentgenogram 4 years ago and since then the size of the mass had gradually increased (Fig 1). However, she did not develop angina-like chest pain on effort.Physical examination revealed a grade 4/6 continuous cardiac murmur at the second intercostal space. Blood pressure was 135/80 mmHg. There was complete right bundle branch block on ECG. Two-dimensional echocardiography revealed a round cystic lesion with internal spontaneous echo contrast, located in contact with the pulmonary trunk (Fig 2). Computed tomography showed a giant mass of 5.8×6.0 cm in diameter into which the left and right coronary arteries drained (Fig 3). During catheterization, oximetry revealed an oxygen step-up of 4% between the pulmonary artery and the right ventricle, consistent with a left-to-right shunt of 3.4%. The pulmonic-to-systemic blood flow ratio (Qp/Qs) was 1.04. Digital subtraction coronary Circulation Journal Vol.66, May 2002 angiography confirmed that each branch of the left anterior descending artery and the right coronary artery drained into the huge aneurysm (Fig 4). However, the efferent vessels into the pulmonary artery were not clearly demonstrated by angiography, but color Doppler flow imaging revealed the small efferent flow was running from the aneurysm to the main pulmonary artery (Fig 5). From these findings, she was diagnosed as having a coronary -pulmonary fistula with a concomitant huge saccular aneurysm that was considered to have progressively enlarged during the preceding 4 years, and surgical resection was proposed.At operation, an egg-shaped, elastic, cardiac tumor 6 cm in diameter was found in front of the right ventricular outflow tract. The afferent vessels were confirmed to arise

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Section: Discussionmentioning

confidence: 99%

Huge Saccular Aneurysm in a Coronary-Pulmonary Fistula Fed by the Left and Right Coronary Arteries.

Hirooka

Hanatani²,

Nakatani³

et al. 2002

Circ J

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“…The Konno criteria are commonly used as indications for surgery [19]:

left-to-right shunt ratio >30%, regardless of symptoms;

signs of ischemia or volume overload in the right ventricle on electrocardiography;

progression of pulmonary hypertension or congestive heart failure;

history of infective endocarditis;

aneurysm formation in the coronary artery.

Some authors [20] propose that asymptomatic CAVF could be surgically treated to prevent the occurrence of coronary artery disease or infective endocarditis. Although spontaneous CAVF closure has been reported in pediatric cases [21], spontaneous closure is unlikely in adults. CAAs >3 cm in diameter are at the risk of rupture [22].…”

Section: Discussionmentioning

confidence: 99%

A Case Report of Coronary Arteriovenous Fistulas with an Unruptured Coronary Artery Aneurysm Successfully Treated by Surgery

Takeuchi

Takada

Nishibori

et al. 2012

Case Reports in Cardiology

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A 58-year-old female with a history of Wolff-Parkinson-White syndrome presented at our institution with palpitations and chest pain. Electrocardiography revealed paroxysmal supraventricular tachycardia with a heart rate of 188 beats/min. Antiarrhythmic drugs were ineffective, and tachycardia was resolved by electrical cardioversion. Transthoracic echocardiography revealed abnormal vessels around the right coronary artery (RCA) and pulmonary artery (PA); in addition, we suspected coronary arteriovenous fistula (CAVF). Coronary angiography and coronary computed tomography revealed dilated fistula vessels, with a 1 cm saccular aneurysm around the RCA, originating from the proximal RCA and left anterior descending artery into the main trunk of PA. Therefore, we confirmed the diagnosis of CAVF with an unruptured aneurysm. We surgically ligated and clipped the fistula vessels and resected the aneurysm. The resected aneurysm measured 1 × 1 cm in size. Pathological examination of the resected aneurysm revealed hypertrophic walls comprising proliferating fibroblasts cells thin elastic fibers. Very few atherosclerotic changes manifested in the aneurysm walls. We report the case of a patient with CAVF and an unruptured coronary artery aneurysm who was successfully treated by surgery.

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“…In general, congestive car diac failure occurs only when communication is large and usually appears in the fourth decade or later. Other rare complications reported were myocar dial ischaemia, infective endocarditis, or rupture of the aneurysm [7], Although it seems clear that symptomatic patients with large communica tions should have their fistulae closed, the role of surgery in asymptomatic patients remains uncertain [19]. Closure can be done by simply ligating the fistula at its point of entry into the receiving chamber as was done in our case I. Alternatively, extracorporeal circulation may be used to achieve clo sure of the coronary artery fistula either from inside the involved chamber or via an arteriotomy, directly over the site of fistula [11], Many cases of successful operations involving coronary fistulae draining both into the right as well as the left side of the heart have been reported in the literature [7,11,20], Due to the presence of multiple fistulae involving all three major coronary arteries in our case 3, and the left anterior, descending and circum flex artery in our case 4, it was elected not to advise operation because of the great difficulties in ligating all the abnormal communicating channels to the left ventricle.…”

Section: Discussionmentioning

confidence: 99%

Coronary Artery-Left Ventricular Fistula

et al. 1981

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Coronary artery-left ventricular fistulae are exceedingly rare and to date only 19 cases have been reported in the literature. We describe another four cases which we encountered recently. The first patient was a 10-year-old asymptomatic Indian male who was referred because of a to-and-fro murmur. Haemodynamic and angiographic studies revealed an aneurysmally enlarged right coronary artery draining into the left ventricle. The fistula was ligated and the patient has remained well over a 2½-year follow-up period. The second patient was a 13-year-old asymptomatic Chinese female referred also because of a to-and-fro murmur. Haemodynamic and angiographic studies showed a grossly enlarged right coronary artery draining into the left ventricle. This patient refused operation and has remained well over a 2-year follow-up period. The third patient was a 43-year-old Chinese male who presented with a 3-year history of angina pectoris and was admitted to hospital because of crescendo angina. The resting electrocardiogram showed marked ischaemic changes and the treadmill exercise stress test was also positive. Selective coronary angiography showed markedly dilated right and left coronary arteries. Multiple fistulae from the three major coronary arteries were seen to communicate with the left ventricle. It was elected to treat this patient medically with propranolol. He has remained well over a 6-month follow-up period. The fourth patient was a 5-year-old asymptomatic Chinese girl. Cardiac catheterization and selective coronary angiography revealed marked dilatation of the branches of the left coronary artery which communicated via a maize of fine vessels into the left ventricle. This patient has remained well over a 5-year follow-up period. The clinical presentation, investigations and treatment of coronary artery-left ventricular fistula are discussed and the literature regarding this subject is reviewed.

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Spontaneous near closure of coronary artery fistula.

Cited by 32 publications

References 22 publications

Huge Saccular Aneurysm in a Coronary-Pulmonary Fistula Fed by the Left and Right Coronary Arteries.

Huge Saccular Aneurysm in a Coronary-Pulmonary Fistula Fed by the Left and Right Coronary Arteries.

A Case Report of Coronary Arteriovenous Fistulas with an Unruptured Coronary Artery Aneurysm Successfully Treated by Surgery

Coronary Artery-Left Ventricular Fistula

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