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Torres S, Vasconcelos M, Tavares Silva M, Moreira J, Silva JC, Macedo F. Coronary artery fistulas: A 12-year single-center experience. Rev Port Cardiol 2022; 41:843-850. [DOI: 10.1016/j.repc.2021.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/05/2021] [Accepted: 06/21/2021] [Indexed: 10/15/2022] Open
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Jabri A, Shahrori Z, Nasser MF, Bullinger K, Alameh A, Haddadin F, Al-Abdouh A. Right Coronary Artery to Right Atrial Fistula: Role of Multi-Modality Imaging and Percutaneous Closure. Cureus 2022; 14:e26716. [PMID: 35959183 PMCID: PMC9360630 DOI: 10.7759/cureus.26716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2022] [Indexed: 11/13/2022] Open
Abstract
Coronary artery fistula (CAF) is a connection between a coronary artery and a cardiac chamber or nearby vessel. Our case represents a fistula arising from the right coronary artery and terminating in the right atrium, presenting as atrial fibrillation. CAF closure options include surgical and percutaneous approaches.
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Saighi Bouaouina M, Perier M, Kechabtia K, Aymard A, Van Belle E, Perdrix C, Benamer H. Transcatheter Occlusion of Coronary-Pulmonary Fistula With a Liquid Embolic Agent After Evaluation by FFR. JACC Case Rep 2022; 4:391-394. [PMID: 35693909 PMCID: PMC9175142 DOI: 10.1016/j.jaccas.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/26/2021] [Accepted: 11/05/2021] [Indexed: 11/03/2022]
Abstract
A 58-year-old man was admitted for stable angina. The coronary angiogram revealed a coronary-pulmonary fistula with a nonsignificant atheroma. We decided to perform percutaneous embolization of the fistula in view of the symptoms and the hemodynamic assessment findings. Embolization was performed using a liquid embolic agent with no residual flow. (Level of Difficulty: Intermediate.)
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Congenital Aorto-Cardiac Connections (CACC) Revisited: Introduction of a Novel Anatomic-therapeutic Classification. Pediatr Cardiol 2021; 42:1459-1477. [PMID: 34327543 DOI: 10.1007/s00246-021-02671-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/23/2021] [Indexed: 10/20/2022]
Abstract
Abnormal congenital aorto-cardiac communications (CACC) are a heterogeneous constellation of anomalies that provide an abnormal connection between the aorta and other cardiac chambers or structures, including the atria, ventricles, the main pulmonary artery, and the coronary sinus. The current terminology of CACC has significant errors and shortcomings including inconsistent and interchangeable use of terms of fistula and tunnel and lack of an inclusive classification with practical information on therapeutic management. The aims of this study were threefold: firstly, to perform a concise narrative review of congenital pathologic connections between the aortic root and cardiac chambers which include rupture of congenital sinus of Valsalva aneurysm, aorto-left ventricular and less commonly right ventricular tunnels, coronary cameral fistulas, and aorto-atrial communications; secondly, to investigate the differentiating features of the so-called aorta right atrial tunnel (ARAT), with and without coronary artery take-off from the tunnel, and coronary cameral fistula (CCF) by applying a differential diagnostic assistance toolbox to two groups of patients with ARAT and CCF; and lastly, to propose a practical and inclusive anatomic-therapeutic classification for CACCs. The two main cornerstones of the proposed classification are the type of the connector between the aorta and cardiac chamber (hole versus passage) and the nature of the connecting passage ( anatomic versus extra-anatomic). We classified CACCs into three types. Depending on the intramural versus extramural course of the extra-anatomic connecting passage, type 3 is further subdivided into type 3A and type 3B.
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Kubota S, Hara H, Yamamoto M, Hiroi Y. Percutaneous Coil Embolization of Confluent Bilateral Coronary Artery Fistulas. JACC Case Rep 2020; 2:991-995. [PMID: 34317400 PMCID: PMC8302086 DOI: 10.1016/j.jaccas.2020.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/03/2020] [Accepted: 04/13/2020] [Indexed: 10/29/2022]
Abstract
A 52-year-old woman presented with a continuous heart murmur at an annual health examination. Coronary computed tomography angiography showed confluent coronary artery fistulas meeting to form a large aneurysm fistulizing to the pulmonary artery. Percutaneous coil embolization was performed, resulting in the disappearance of the coronary artery fistulas and aneurysms. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Shuji Kubota
- Department of Cardiology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hisao Hara
- Department of Cardiology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masaya Yamamoto
- Department of Cardiology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yukio Hiroi
- Department of Cardiology, National Center for Global Health and Medicine, Tokyo, Japan
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Said SA, Agool A, Moons AH, Basalus MW, Wagenaar NR, Nijhuis RL, Schroeder-Tanka JM, Slart RH. Incidental congenital coronary artery vascular fistulas in adults: Evaluation with adenosine- 13N-ammonia PET-CT. World J Cardiol 2018; 10:153-164. [PMID: 30386493 PMCID: PMC6205851 DOI: 10.4330/wjc.v10.i10.153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/21/2018] [Accepted: 08/30/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To assess the functionality of congenital coronary artery fistulas (CAFs) using adenosine stress 13N-ammonia positron emission tomography computed tomography (PET-CT). METHODS Congenital CAFs were incidentally detected during coronary angiography (CAG) procedures in 11 adult patients (six males and five females) with a mean age of 64.3 years (range 41-81). Patients were collected from three institutes in the Netherlands. The characteristics of the fistulas (origin, pathway and termination), multiplicity of the origins and pathways of the fistulous vessels were assessed by CAG. Five patients underwent adenosine pharmacologic stress 13N-ammonia PET-CT to assess myocardial perfusion and the functional behavior of the fistula. RESULTS Eleven patients with 12 CAFs, 10 unilateral and one bilateral, originating from the left anterior descending coronary artery (n = 8), right coronary artery (n = 2) and circumflex (n = 2). All fistulas were of the vascular type, terminating into either the pulmonary artery (n = 11) or coronary sinus (n = 1). The CAG delineated the characteristics of the fistula (origin, pathway and termination). Multiplicity of the origins and pathways of the fistulous vessels were common in most fistulas (8/12, 67% and 9/12, 75%, respectively). Multiplicity was common among the different fistula components (23/36, 64%). Adenosine pharmacologic stress 13N-ammonia PET-CT revealed normal myocardial perfusion and ejection fraction in all but one patient, who showed a reduced ejection fraction. CONCLUSION PET-CT may be helpful for assessing the functional status of congenital CAFs in selected patients regarding clinical decision-making. Studies with a larger patient series are warranted.
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Affiliation(s)
- Salah Am Said
- Department of Cardiology, Hospital Group Twente, Almelo-Hengelo 7555 DL, Overijssel, The Netherlands.
| | - Aly Agool
- Department of Nuclear Medicine, Hospital Group Twente, Almelo-Hengelo 7555 DL, Overijssel, The Netherlands
| | - Arno Hm Moons
- Department of Cardiology, Slotervaart Hospital, Amsterdam 1066 EC, North Holland, The Netherlands
| | - Mounir Wz Basalus
- Department of Cardiology, Hospital Group Twente, Almelo-Hengelo 7555 DL, Overijssel, The Netherlands
| | - Nils Rl Wagenaar
- Department of Nuclear Medicine, Hospital Group Twente, Almelo-Hengelo 7555 DL, Overijssel, The Netherlands
| | - Rogier Lg Nijhuis
- Department of Cardiology, Hospital Group Twente, Almelo-Hengelo 7555 DL, Overijssel, The Netherlands
| | - Jutta M Schroeder-Tanka
- Department of Cardiology, Hospital Onze Lieve Vrouwe Gasthuis, Location West, Amsterdam 1061 AE, North Holland, The Netherlands
| | - Riemer Hja Slart
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen 9713 GZ, The Netherlands
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Buccheri D, Chirco PR, Geraci S, Caramanno G, Cortese B. Coronary Artery Fistulae: Anatomy, Diagnosis and Management Strategies. Heart Lung Circ 2018; 27:940-951. [PMID: 29503240 DOI: 10.1016/j.hlc.2017.07.014] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 04/03/2017] [Accepted: 07/10/2017] [Indexed: 12/27/2022]
Abstract
Coronary artery fistula (CAF) is a relatively rare anatomic abnormality of the coronary arteries that afflicts 0.002% of the general population and represents 14% of all the anomalies of coronary arteries. Its clinical relevance focusses mainly on the mechanism of "coronary steal phenomenon", causing myocardial functional ischaemia even in the absence of stenosis, hence common symptoms are angina or effort dyspnoea. The suggested diagnostic approach is guided by the patient's symptoms and consists of a number of instrumental examinations like ECG, treadmill test, echocardiography, computed tomography scan, cardiac magnetic resonance and coronary angiography. If it is not an incidental finding, coronary angiography is required in view of the optimal therapeutic planning. Small-sized fistulae are usually asymptomatic and have an excellent prognosis if managed medically with clinical follow-up with echocardiography every 2 to 5 years. In the case of symptomatic, large-sized or giant fistulae an invasive treatment, by transcatheter approach or surgical ligation, is usually a reasonable choice, and both strategies show equivalent results at long-term follow-up. Antibiotic prophylaxis for the prevention of bacterial endocarditis is recommended in all patients with coronary artery fistulae who undergo dental, gastrointestinal or urological procedures. A life-long follow-up is always essential to ensure that the patient is not undergoing progression of disease or further cardiac complications.
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Affiliation(s)
- Dario Buccheri
- Interventional Cardiology, San Giovanni di Dio Hospital, Agrigento, Italy.
| | - Paola Rosa Chirco
- Emergency Department, Paolo Giaccone University Hospital, Palermo, Italy
| | - Salvatore Geraci
- Interventional Cardiology, San Giovanni di Dio Hospital, Agrigento, Italy
| | - Giuseppe Caramanno
- Interventional Cardiology, San Giovanni di Dio Hospital, Agrigento, Italy
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Epicardial 15-MHz Echocardiography for Effective Repair of Coronary Arteriovenous Fistula. Ann Thorac Surg 2017; 105:e41-e43. [PMID: 29233364 DOI: 10.1016/j.athoracsur.2017.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 08/06/2017] [Accepted: 09/10/2017] [Indexed: 11/23/2022]
Abstract
In the era of catheter intervention, the surgical repair of coronary arteriovenous fistula needs to be free from residual shunt. Intraoperative epicardial 15-MHz echocardiography helps to find the residual shunt after ligation or obliteration of anomalous vessels. Here we report our method of the echo-assisted surgical repair of coronary arteriovenous fistula in 7 adult patients. The method made the operation for coronary arteriovenous fistula free from residual shunt, but care should be taken to the development of new vessels after the operation.
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Lee SK, Jung JI, O JH, Kim HW, Youn HJ. Coronary-to-pulmonary artery fistula in adults: Evaluation with thallium-201 myocardial perfusion SPECT. PLoS One 2017; 12:e0189269. [PMID: 29216309 PMCID: PMC5720796 DOI: 10.1371/journal.pone.0189269] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 11/20/2017] [Indexed: 12/25/2022] Open
Abstract
Objectives With the increasing use of multi-detector CT, the number of detected cases with coronary-to-pulmonary artery fistula (CPAF) has increased. Several previous studies reported severe cases of angina, but no appropriate tests to evaluate myocardial perfusion for patients with CPAF have been established. We evaluated the hemodynamic characteristics of CPAF using thallium-201 (Tl-201) single photon emission computed tomography (SPECT). Materials and methods Tl-201 SPECT was performed in 17 patients with CPAF, but without evidence of coronary artery disease on coronary computed tomography angiography (CCTA) (age, 58.5±13.3 years; 8 men). Quantitative analysis of scintigraphic data was performed. Additionally, perfusion abnormalities were compared with CCTA findings. Medical records were obtained to define clinical data, diagnostic findings, symptoms, management, follow-up data, and major adverse cardiac events (MACE). Results Six patients (35.2%) showed perfusion abnormalities on SPECT studies and could be classified as follows: 3 patients, no reversible ischemia (3/17, 17.6%); 1 patient, mild ischemia (1/17, 5.8%); and 2 patients, moderate ischemia (2/17, 11.7%). During the follow-up, ten patients (58.8%) improved under medical management and 5 patients (29.4%) underwent surgical ligation for CPAF with symptomatic improvement in 4 patients. Seven patients performed follow-up myocardial perfusion SPECT, and symptomatic improvement correlated well with scintigraphic perfusion improvement in 6 patients No MACE was observed. Clinical significance Tl-201 myocardial perfusion SPECT might be useful for determining the hemodynamic status and for risk stratification in patients with CPAF.
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Affiliation(s)
- Seul Ki Lee
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jung Im Jung
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joo Hyun O
- Department of Nuclear Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hwan Wook Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ho Joong Youn
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Ahmed TA, Hassan AK, Othman MH, Hasan-Ali H, Dimitry SR, Kishk YT. Novel strategy in endovascular treatment of coronary steal using histoacryl®. Egypt Heart J 2016. [DOI: 10.1016/j.ehj.2016.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Gasparovic I, Artemiou P, Hudec V, Hulman M. Recurrence of coronary arteriovenous fistulae in a rare case of bilateral right coronary and circumflex artery arteriovenous fistulae to the pulmonary artery. Hellenic J Cardiol 2016; 58:226-227. [PMID: 27663960 DOI: 10.1016/j.hjc.2016.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 07/27/2016] [Accepted: 08/08/2016] [Indexed: 11/16/2022] Open
Affiliation(s)
- Ivo Gasparovic
- Medical Faculty of the Slovak Health University, National Institute for Cardiovascular Diseases, Clinic of Cardiac Surgery, Bratislava, Slovakia
| | - Panagiotis Artemiou
- Medical Faculty of the Slovak Health University, National Institute for Cardiovascular Diseases, Clinic of Cardiac Surgery, Bratislava, Slovakia.
| | - Vladan Hudec
- Medical Faculty of the Slovak Health University, National Institute for Cardiovascular Diseases, Clinic of Cardiac Surgery, Bratislava, Slovakia
| | - Michal Hulman
- Medical Faculty of the Slovak Health University, National Institute for Cardiovascular Diseases, Clinic of Cardiac Surgery, Bratislava, Slovakia
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A call to action for an underestimated entity: Our algorithm for diagnosis and management of coronary artery fistula. Int J Cardiol 2016; 221:1081-3. [PMID: 27448536 DOI: 10.1016/j.ijcard.2016.07.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 07/04/2016] [Indexed: 11/20/2022]
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Coronary artery fistula: a review. Cardiovasc Pathol 2015; 24:141-8. [DOI: 10.1016/j.carpath.2014.01.010] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 01/31/2014] [Accepted: 01/31/2014] [Indexed: 11/19/2022] Open
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Zamani H, Meragi M, Arabi Moghadam MY, Alizadeh B, Babazadeh K, Mokhtari-Esbuie F. Clinical presentation of coronary arteriovenous fistula according to age and anatomic orientation. CASPIAN JOURNAL OF INTERNAL MEDICINE 2015; 6. [PMID: 26221510 PMCID: PMC4478461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Coronary arteriovenous fistulas (CAVFs) are direct connections from one or more coronary arteries to cardiac chambers or a large vessel. They are mostly of congenital origin. The aim of this study was to describe clinical presentation and also delineate the course and management of CAVF. METHODS Clinical data, chest x-rays, echocardiographic and angiographic evaluation of 40 patients with congenital CAVF during 1990 to 2008 were reviewed retrospectively. RESULTS Seventeen patients were ≤ 20 years old (42.5%) were mostly asymptomatic, and twenty tree cases were older than 20 years old (57.5%), mostly symptomatic (P<0.05). Twenty one (52.5%) patients had pure CAVF and nineteen (47.5%) patients with associated intarcardiac congenital heart disease (15%) or acquired valvular and coronary arteries diseases (32.5%). CAVFs mostly originated from left anterior descending artery (LAD) (42.5%) and mostly drained into the main pulmonary artery (MPA) (35 %). Twenty-four patients underwent CAVF surgical ligation. From twenty-one patients with pure CAVF, eight (38%) patients were complicated by congestive heart failure and aneurism formation of fistula. CONCLUSION Unlike some previous reports, in our study, the most prevalent origin site for CAVFs was the left anterior descending (LAD). Most patients with CAVFs especially those who went first diagnosed before 20 years old were asymptomatic. On the other hand, as the continuous murmur is not always detected in children or infants, consequently, cases of spontaneous closure may remain undetected. All symptomatic and asymptomatic patients with moderate to severe shunting should be operated on and minimal morbidity and good surgical results could be expected.
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Affiliation(s)
- Hassan Zamani
- Non-Communicable Pediatric Diseases Research Center, Babol University of Medical Sciences, Babol, IR Iran.,Correspondence: Hassan Zamani, Non-Communicable Pediatric Diseases Research Center, Babol University of Medical Sciences, Babol, IR Iran. E-mail: ,Tel: 0098 11 32346963 ,Fax: 0098 11 32346963
| | - Mahmoud Meragi
- Pediatric Cardiology Department of Shahid Rajaie Heart Center, Iran University of Medical Sciences, Tehran, Iran
| | | | | | - Kazem Babazadeh
- Non-Communicable Pediatric Diseases Research Center, Babol University of Medical Sciences, Babol, IR Iran
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Said SAM, Nijhuis RLG, Akker JWOD, Takechi M, Slart RHJA, Bos JS, Hoorntje CR, Houwelingen KGV, Bakker-de Boo M, Braam RL, Vet TMWJ. Unilateral and multilateral congenital coronary-pulmonary fistulas in adults: clinical presentation, diagnostic modalities, and management with a brief review of the literature. Clin Cardiol 2014; 37:536-45. [PMID: 25196980 DOI: 10.1002/clc.22297] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Revised: 04/18/2014] [Accepted: 04/20/2014] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Congenital coronary-pulmonary fistulas (CPFs) are commonly unilateral, but bilateral and multilateral fistulas may occur. In multilateral CPFs, the value of a multidetector computed tomography (MDCT) imaging technique as an adjuvant to coronary angiography (CAG) is eminent. The purpose of this study was to describe the clinical presentation, diagnostic modalities, and management of coincidentally detected congenital CPFs. HYPOTHESIS Unilateral and multilateral coronary-pulmonary fistulas are increasingly detected due to the wide speard application of multidetector computed tomography which might be a supplementary or replacing to conventional coronary angiography. METHODS We evaluated 14 adult patients with congenital coronary artery fistulas (CAFs) who were identified from several Dutch cardiology departments. RESULTS Fourteen adult patients (5 female and 9 male), with a mean age of 57.5 years (range, 24-80 years) had the following abnormal findings: audible systolic cardiac murmur (n = 4), chronic atrial fibrillation (n = 2), nonsustained ventricular tachycardia (n = 1), and cardiomegaly on chest x-ray (n = 2). Echocardiography revealed normal findings with trivial valvular abnormalities (n = 9), depressed left ventricle systolic function (n = 3), and severe mitral regurgitation and atrial dilatation (n = 2). The findings in the rest of the patients were unremarkable. CAG and MDCT were used as a diagnostic imaging techniques either alone (CAG, n = 6; MDCT, n = 1) or in combination (n = 7). Single modality and multimodality diagnostic methods revealed 22 fistulas including CPFs (n = 15), coronary cameral fistulas terminating into the right (n = 2) and the left atrium (n = 1), and systemic-pulmonary fistulas (n = 4). Of all of the fistulas, 10 were unilateral, 6 were bilateral, and 6 was hexalateral. (13) N-ammonia positron emission tomography-computed tomography was performed in 3 patients revealing decreased myocardial perfusion reserve. CONCLUSIONS CAG remains the gold standard for detection of CPFs. An adjuvant technique using MDCT provides full anatomical details of the fistulas.
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Affiliation(s)
- Salah A M Said
- Department of Cardiology, Hospital Group Twente, Hengelo, the Netherlands
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Challoumas D, Pericleous A, Dimitrakaki IA, Danelatos C, Dimitrakakis G. Coronary arteriovenous fistulae: a review. Int J Angiol 2014; 23:1-10. [PMID: 24940026 DOI: 10.1055/s-0033-1349162] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Coronary arteriovenous fistulae are a coronary anomaly, presenting in 0.002% of the general population. Their etiology can be congenital or acquired. We present a review of recent literature related to their epidemiology, etiology, pathophysiology, clinical presentation, diagnostic approach, and therapeutic management.
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Affiliation(s)
- Dimitris Challoumas
- School of Medicine, Cardiff University, Heath Park Campus, Cardiff, United Kingdom
| | - Agamemnon Pericleous
- School of Medicine, Cardiff University, Heath Park Campus, Cardiff, United Kingdom
| | | | | | - Georgios Dimitrakakis
- Department of Cardiothoracic Surgery, University Hospital of Wales, Cardiff, United Kingdom
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Said SAM, Oortman RM, Hofstra JH, Verhorst PMJ, Slart RHJA, de Haan MW, Eerens F, Crijns HJGM. Coronary artery-bronchial artery fistulas: report of two Dutch cases with a review of the literature. Neth Heart J 2014; 22:139-47. [PMID: 24464641 PMCID: PMC3954926 DOI: 10.1007/s12471-014-0518-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Coronary bronchial artery fistulas (CBFs) are rare anomalies, which may be isolated or associated with other disorders. Materials and methods Two adult patients with CBFs are described and a PubMed search was performed using the keywords “coronary bronchial artery fistulas” in the period from 2008 to 2013. Results Twenty-seven reviewed subjects resulting in a total of 31 fistulas were collected. Asymptomatic presentation was reported in 5 subjects (19 %), chest pain (n = 17) was frequently present followed by haemoptysis (n = 7) and dyspnoea (n = 5). Concomitant disorders were bronchiectasis (44 %), diabetes (33 %) and hypertension (28 %). Multimodality and single-modality diagnostic strategies were applied in 56 % and 44 %, respectively. The origin of the CBFs was the left circumflex artery in 61 %, the right coronary artery in 36 % and the left anterior descending artery in 3 %. Management was conservative (22 %), surgical ligation (11 %), percutaneous transcatheter embolisation (30 %), awaiting lung transplantation (7 %) or not reported (30 %). Conclusions CBFs may remain clinically silent, or present with chest pain or haemoptysis. CBFs are commonly associated with bronchiectasis and usually require a multimodality approach to be diagnosed. Several treatment strategies are available. This report presents two adult cases with CBFs and a review of the literature.
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Affiliation(s)
- S A M Said
- Department of Cardiology, Hospital Group Twente, Geerdinksweg 141, 7555 DL, Hengelo, the Netherlands,
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Two cases of aorto-right atrial tunnel: clinical presentation, imaging and percutaneous closure. Neth Heart J 2012; 20:509-12. [PMID: 23100093 DOI: 10.1007/s12471-012-0330-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Communication between the aortic sinus and a cardiac chamber is a rare anomaly that can be diagnosed in children and young adults. We describe two cases with a tunnel between the aortic sinus and right atrium, discuss diagnostic modalities, and review the literature on this anomaly.
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19
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Said SA. Current characteristics of congenital coronary artery fistulas in adults: A decade of global experience. World J Cardiol 2011; 3:267-77. [PMID: 21876777 PMCID: PMC3163242 DOI: 10.4330/wjc.v3.i8.267] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 06/16/2011] [Accepted: 06/23/2011] [Indexed: 02/06/2023] Open
Abstract
AIM To describe the characteristics of coronary artery fistulas (CAFs) in adults, including donor vessels and whether termination was cameral or vascular. METHODS A PubMed search was performed for articles between 2000 and 2010 to describe the current characteristics of congenital CAFs in adults. A group of 304 adults was collected. Clinical data, presentations, diagnostic modalities, angiographic fistula findings and treatment strategies were gathered and analyzed. With regard to CAF origin, the subjects were tabulated into unilateral, bilateral or multilateral fistulas and compared. The group was stratified into two major subsets according to the mode of termination; coronary-cameral fistulas (CCFs) and coronary-vascular fistulas (CVFs). A comparison was made between the two subsets. Fistula-related major complications [aneurysm formation, infective endocarditis (IE), myocardial infarction (MI), rupture, pericardial effusion (PE) and tamponade] were described. Coronary artery-ventricular multiple micro-fistulas and acquired CAFs were excluded as well as anomalous origin of the coronary arteries from the pulmonary artery (PA). RESULTS A total of 304 adult subjects (47% male) with congenital CAFs were included. The mean age was 51.4 years (range, 18-86 years), with 20% older than 65 years of age. Dyspnea (31%), chest pain (23%) and angina pectoris (21%) were the prevalent clinical presentations. Continuous cardiac murmur was heard in 82% of the subjects. Of the applied diagnostic modalities, chest X-ray showed an abnormal shadow in 4% of the subjects. The cornerstone in establishing the diagnosis was echocardiography (68%), and conventional contrast coronary angiography (97%). However, multi-slice detector computed tomography was performed in 16%. The unilateral fistula originated from the left in 69% and from the right coronary artery in 31% of the subjects. Most patients (80%) had unilateral fistulas, 18% presented with bilateral fistulas and 2% with multilateral fistulas. Termination into the PA was reported in unilateral (44%), bilateral (73%) and multilateral (75%) fistulas. Fistulas with multiple origins (bilateral and multilateral) terminated more frequently into the PA (29%) than into other sites (10.6%) (P = 0.000). Aneurysmal formation was found in 14% of all subjects. Spontaneous rupture, PE and tamponade were reported in 2% of all subjects. In CCFs, the mean age was 46.2 years whereas in CVFs mean age was 55.6 years (P = 0.003). IE (4%) was exclusively associated with CCFs, while MI (2%) was only found in subjects with CVFs. Surgical ligation was frequently chosen for unilateral (57%), bilateral (51%) and multilateral fistulas (66%), but percutaneous therapeutic embolization (PTE) was increasingly reported (23%, 17% and 17%, respectively). CONCLUSION Congenital CAFs are currently detected in elderly patients. Bilateral fistulas are more frequently reported and PTE is more frequently applied as a therapeutic strategy in adults.
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Affiliation(s)
- Salah Am Said
- Salah AM Said, Department of Cardiology, Hospital Group Twente, Location Hengelo, 7555 DL Hengelo, The Netherlands
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