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Sancaktar A, Ekici F, Özçobanoğlu S. Acquired multiple coronary artery fistulas: a rare complication of congenital heart surgery in a child diagnosed with right heart valve endocarditis. Cardiol Young 2024:1-3. [PMID: 39344200 DOI: 10.1017/s1047951124026167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/01/2024]
Abstract
Majority of coronary artery fistulas are of the congenital origin, and they have been rarely reported after congenital heart surgery. Here, we present echocardiographic images and prognosis of multiple acquired coronary artery fistulas occurring after surgical myectomy in a child diagnosed with double-chamber right ventricle complicated with infective endocarditis involving the right heart valves.
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Affiliation(s)
- Arife Sancaktar
- Department of Pediatric Cardiology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Filiz Ekici
- Department of Pediatric Cardiology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Salih Özçobanoğlu
- Department of Cardiovascular Surgery, Akdeniz University Faculty of Medicine, Antalya, Turkey
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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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3
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Postsurgical coronary artery fistula after tetralogy of fallot repair. CIRUGIA CARDIOVASCULAR 2021. [DOI: 10.1016/j.circv.2021.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Frommelt P, Lopez L, Dimas VV, Eidem B, Han BK, Ko HH, Lorber R, Nii M, Printz B, Srivastava S, Valente AM, Cohen MS. Recommendations for Multimodality Assessment of Congenital Coronary Anomalies: A Guide from the American Society of Echocardiography: Developed in Collaboration with the Society for Cardiovascular Angiography and Interventions, Japanese Society of Echocardiography, and Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr 2020; 33:259-294. [PMID: 32143778 DOI: 10.1016/j.echo.2019.10.011] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Peter Frommelt
- Children's Hospital of Wisconsin and the Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Leo Lopez
- Stanford University, Palo Alto, California
| | | | | | - B Kelly Han
- Children's Minnesota and the Minneapolis Heart Institute, Minneapolis, Minnesota
| | - H Helen Ko
- Kravis Children's Hospital, Mount Sinai Medical Center, New York, New York
| | - Richard Lorber
- Baylor College of Medicine, Children's Hospital of San Antonio, San Antonio, Texas
| | - Masaki Nii
- Shizuoka Children's Hospital, Shizuoka, Shizuoka, Japan
| | - Beth Printz
- University of California San Diego and Rady Children's Hospital, San Diego, California
| | | | - Anne Marie Valente
- Boston Children's Hospital, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Meryl S Cohen
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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5
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The role of multislice computed tomography in the diagnosis of coronary artery fistulas. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 26:52-57. [PMID: 32082711 DOI: 10.5606/tgkdc.dergisi.2018.14321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 05/30/2017] [Indexed: 11/21/2022]
Abstract
Background This study aims to investigate the frequency and the anatomical features of coronary artery fistulas in patients undergoing multislice computed tomographic angiography for various reasons. Methods Between January 2009 and July 2015, a total of 40 coronary artery fistulas of 26 patients were retrospectively analyzed using multislice computed tomographic angiography in our clinic. The affected arteries and localizations of the fistulas were evaluated. Results Of the fistulas, 11 (27.5%) were originating from the circumflex artery, 10 (25%) from the left anterior descending artery, four (10%) from the diagonal arteries, three (7.5%) from the left main coronary artery, three (7.5%) from the right main coronary artery, three (7.5%) from the septal artery, three (7.5%) from the conus artery, one (2.5%) from the obtuse marginal artery, one (2.5%) from left anterior descending artery proper (dual LAD), and one (2.5%) from the ramus intermedius. One of the conus arteries was directly originating from the right coronary sinus. Twelve (30%) of the fistulas were draining into the pulmonary trunk, eight (20%) into the left ventricle, seven (17.5%) into the right ventricle, five (12.5%) into the superior vena cava, three (7.5%) into the right main pulmonary artery, two (5%) into the right atrium, one (2.5%) into the left atrium, one (2.5%) into the right internal thoracic artery, and one (2.5%) into the sinus coronarius. Conclusion Compared to conventional angiography, multislice computed tomographic angiography is a non-invasive modality which allows enhancing coronary artery fistulas at a higher rate and visualizing the cardiac anatomy in detail.
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Zhou Z, Xu L, Zhang N, Wang H, Liu W, Sun Z, Fan Z. CT coronary angiography findings in non-atherosclerotic coronary artery diseases. Clin Radiol 2017; 73:205-213. [PMID: 28797768 DOI: 10.1016/j.crad.2017.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 07/02/2017] [Accepted: 07/06/2017] [Indexed: 12/19/2022]
Abstract
Non-atherosclerotic coronary artery diseases are being increasingly recognised as causes of acute coronary events. Invasive coronary angiography frequently fails to identify the abnormalities in the proximal course of coronary arteries and coronary wall, while computed tomography coronary angiography (CTCA) allows for acquisition of more detailed information. CTCA serves as a reliable method for evaluating patients with non-atherosclerotic coronary artery diseases. The purpose of this article is to provide an overview of non-atherosclerotic abnormalities that may be demonstrated on CTCA.
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Affiliation(s)
- Z Zhou
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Rd, Chaoyang District, Beijing, 100029, China
| | - L Xu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Rd, Chaoyang District, Beijing, 100029, China.
| | - N Zhang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Rd, Chaoyang District, Beijing, 100029, China
| | - H Wang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Rd, Chaoyang District, Beijing, 100029, China
| | - W Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Rd, Chaoyang District, Beijing, 100029, China
| | - Z Sun
- Department of Medical Radiation Sciences, Curtin University, Perth, WA 6845, Australia
| | - Z Fan
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Rd, Chaoyang District, Beijing, 100029, China
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Firuzi A, Alemzadeh-Ansari MJ, Pouraliakbar HR. Transcatheter coil embolization of iatrogenic coronary artery-left ventricle fistula after mitral valve replacement. J Saudi Heart Assoc 2017; 29:148-152. [PMID: 28373791 PMCID: PMC5366659 DOI: 10.1016/j.jsha.2016.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 10/25/2016] [Accepted: 10/31/2016] [Indexed: 11/02/2022] Open
Abstract
Acquired causes of coronary fistulas are rare disorders and may develop following coronary atherosclerosis, infection, or trauma (iatrogenic). Iatrogenic coronary fistulas may be acquired secondary to surgical or nonsurgical interventions. We describe a case of an iatrogenic coronary artery-left ventricle fistula following mitral valve replacement surgery, presented with ventricular arrhythmia and heart failure. In a unique technique, we implanted three coils with the aid of a Scepter C balloon with inflation at the ostial portion of the left circumflex artery.
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Affiliation(s)
- Ata Firuzi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, aIran
| | - Mohammad Javad Alemzadeh-Ansari
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, aIran
| | - Hamid Reza Pouraliakbar
- Radiology Department, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, bIran
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Manoly I, Mahadevan VS, Hoschtitzky JA. Hybrid Approach to Closure of an Acquired Coronary-Cameral Fistula. Ann Thorac Surg 2014; 98:e59-61. [DOI: 10.1016/j.athoracsur.2014.05.094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 05/14/2014] [Accepted: 05/27/2014] [Indexed: 10/24/2022]
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Said SAM, Schiphorst RHM, Derksen R, Wagenaar LJ. Coronary-cameral fistulas in adults: Acquired types (second of two parts). World J Cardiol 2013; 5:484-494. [PMID: 24432186 PMCID: PMC3888666 DOI: 10.4330/wjc.v5.i12.484] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 08/25/2013] [Accepted: 10/18/2013] [Indexed: 02/06/2023] Open
Abstract
Acquired coronary artery fistulas (CCFs) are infrequently detected during conventional coronary angiography. To delineate the characteristics of congenital (first part) and acquired (second part) CCFs in adults, a PubMed search was conducted for papers dealing with congenital or acquired CCFs. None of the publications describing patients with coronary-vascular fistulas were included. Papers dealing with pediatric subjects were excluded. From the world literature, a total of 243 adult patients were selected who had congenital (n = 159/243, 65%) and acquired (n = 84/243, 35%) CCFs. Among the acquired types (n = 72, 85.7%) were traumatic (iatrogenic (n = 65/72, 90%), accidental (n = 7/72, 10%) and (n = 12, 14.3%) spontaneously developing in relation to severe coronary atherosclerosis or myocardial infarction. A high incidence of spontaneous resolution of iatrogenic CCFs resulting from endomyocardial biopsy or following post-septal myectomy was reported. Spontaneous CCFs associated with myocardial ischemia or infarction resolved completely in 8% of the subjects. Early surgical intervention was the treatment of choice in acquired traumatic accidental CCFs. The congenital types are addressed in a previous issue of this journal (first part). In this review (second of two parts, part II), we describe the acquired coronary-cameral fistulas.
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Faustino A, Paiva LV, Mota P, Catarino R. Acquired left coronary artery fistulae to pulmonary artery and superior vena cava. BMJ Case Rep 2013; 2013:bcr-2013-202267. [PMID: 24326444 DOI: 10.1136/bcr-2013-202267] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Ana Faustino
- Cardiology Department, Coimbra's Hospital Centre and University, Coimbra, Portugal
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Said A, Helmy I, Hashem K, EssamEldin T. An unusual case of coronary artery fistula to the pulmonary artery, diagnosed with 64-MDCT coronary angiography. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2013. [DOI: 10.1016/j.ejrnm.2013.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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12
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Allen KY, Goldstein BH, Pahl E, Schumacher KR, Gajarski RJ, Backer CL, Wax DF, Kaushal S, Gossett JG. Non-cameral coronary artery fistulae after pediatric cardiac transplantation: A multicenter study. J Heart Lung Transplant 2012; 31:744-9. [PMID: 22445194 DOI: 10.1016/j.healun.2012.02.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Revised: 01/06/2012] [Accepted: 02/11/2012] [Indexed: 10/28/2022] Open
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Acquired left coronary artery fistula to right ventricular outflow tract. Neth Heart J 2011; 16:100-1. [PMID: 18345332 DOI: 10.1007/bf03086126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Mustelier JV, Rego JOC, Aquiles EWO, Llerena LR. Asymptomatic fistula from a giant aneurysmatic left anterior descending artery to the right ventricular outflow tract. J Echocardiogr 2010; 8:121-3. [PMID: 27278942 DOI: 10.1007/s12574-010-0040-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Revised: 03/19/2010] [Accepted: 03/23/2010] [Indexed: 11/29/2022]
Abstract
Coronary artery fistulas are unusual congenital or acquired coronary artery abnormalities in which blood is shunted into a cardiac chamber, great vessel or other structure, bypassing the myocardial capillary network (Jung et al. in Cardiovasc Ultrasound 5:10, 2007). We present a young adult patient with an asymptomatic fistula from a giant aneurysmatic left anterior descending artery to the right ventricular outflow tract, first diagnosed by echocardiography examination and further confirmed by 128-slice computed tomography coronary angiography.
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Affiliation(s)
- Juan Valiente Mustelier
- Department of Echocardiography, National Cardiology and Cardiovascular Surgery Institute, 17 Street No. 702 El Vedado, 10400, Havana, Cuba
| | - Julio Oscar Cabrera Rego
- Department of Echocardiography, National Cardiology and Cardiovascular Surgery Institute, 17 Street No. 702 El Vedado, 10400, Havana, Cuba.
| | - Eddy W Olivares Aquiles
- Department of Radiology and Computed Tomography, National Cardiology and Cardiovascular Surgery Institute, Havana, Cuba
| | - Luis Roberto Llerena
- Department of Radiology and Computed Tomography, National Cardiology and Cardiovascular Surgery Institute, Havana, Cuba
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Zenooz NA, Habibi R, Mammen L, Finn JP, Gilkeson RC. Coronary artery fistulas: CT findings. Radiographics 2009; 29:781-9. [PMID: 19448115 DOI: 10.1148/rg.293085120] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Coronary artery fistulas are anomalous terminations of the coronary arteries. Most often, these fistulas are incidentally identified in the adult and pediatric populations. Many patients are asymptomatic; however, an awareness of these fistulas is important because they have been associated with various clinical features, including chest pain or heart failure in young patients. Correct diagnosis of coronary artery fistulas is important, and early surgical correction is indicated because of the high prevalence of late symptoms and complications. Traditionally, conventional angiography has been used for the diagnosis of coronary anomalies. With more frequent use of 64-row multi-detector computed tomography (CT) in chest and cardiac imaging, the number of incidentally found coronary artery fistulas has been increasing. CT angiography and conventional angiography can have additive value in diagnosis of this cardiac anomaly. In every CT study of the heart, special attention should be paid to the courses and terminations of the coronary arteries to detect these potentially fatal anomalies.
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Affiliation(s)
- Navid A Zenooz
- Department of Radiology, Yale New Haven Hospital, 20 York St, New Haven, CT 06510, USA.
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Yiginer O, Bas S, Feray H. Demonstration of coronary-to-pulmonary fistula with MDCT and conventional angiography. Int J Cardiol 2009; 134:e126-8. [DOI: 10.1016/j.ijcard.2008.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2007] [Accepted: 03/01/2008] [Indexed: 10/22/2022]
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Abstract
BACKGROUND The aim of this study was to investigate the rate, risks factors, and clinical impact of coronary artery fistula (CAF) in Kawasaki disease (KD). METHODS From February 1999 to December 2007, a total of 325 pediatric patients fulfilled the diagnostic criteria of KD and admitted for intravenous immunoglobulin treatment were enrolled in this study. Patients with and without CAF were designated as group 1 and group 2, respectively. Patients of group 1 were further subdivided as with and without coronary artery lesions (CALs). The clinical presentations, laboratory data, and outcomes were compared among the groups. RESULTS The mean age of the 325 patients was 21.1 months. Group 1 had 17 patients, and group 2 had 308 patients. The rate of CAF in KD was 5.3%. There were significant differences between group 1 and group 2 patients regarding age (11.8 +/- 1.8 vs 21.5 +/- 1.2 months, P = .01), the presence of CAL (64.7% vs 25%, P < .01), white blood cell counts (16.4 +/- 1.3 vs 13.5 +/- 0.3 x 10(3)/mm(3), P = .01), and platelet counts (432.1 +/- 39.1 vs 346.4 +/- 8.4 x 10(3)/mm(3), P = .02). Spontaneous closure of CAF was observed in 7 (41%) of the 17 patients during follow-up (mean 45 months). Group 1 patients without CAL had a more benign clinical course (total fever day 5.8 +/- 0.6 vs 8.6 +/- 0.8, P = .03) and higher spontaneous closure rate (5/6 vs 2/11, P = .035) than patients with CAL. CONCLUSIONS Patients of young age, CAL, high white blood cell counts, and high platelet counts have higher rate of CAF formation. Approximately 5% KD patients may associate with CAF, but most of them have good clinical outcome during follow-up.
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Wada T, Ohara T, Nakatani S, Sumita Y, Kobayashi J, Kitakaze M. A case of coronary artery fistula between a coronary artery and the left atrium following maze procedure. J Am Soc Echocardiogr 2009; 22:323.e3-6. [PMID: 19153027 DOI: 10.1016/j.echo.2008.12.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2008] [Indexed: 12/21/2022]
Abstract
The authors report a case of a coronary artery fistula (CAF) after mitral valvuloplasty and a maze procedure. A 73-year-old man was admitted to the hospital with congestive heart failure. He had undergone mitral valvuloplasty and a maze procedure 10 years previously. An abnormal Doppler flow signal in the left atrium was incidentally found on transthoracic echocardiography. It was diagnosed as a CAF on transesophageal echocardiography and other imaging modalities. The detection of the abnormal flow just after the operation suggested a causal relationship between this fistula and the preceding surgical procedure. Acquired CAF following cardiac surgery is a rare abnormality. However, if abnormal flow is found on transthoracic echocardiography after cardiac surgery, this abnormality should be kept in mind.
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Affiliation(s)
- Tadashi Wada
- Division of Cardiology, National Cardiovascular Center, Fujishirodai, Osaka, Japan
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Rudraiah L, Dhar G, Thatai D. Acquired coronary cameral fistula--a report of two cases. Int J Cardiol 2007; 123:e40-2. [PMID: 17303268 DOI: 10.1016/j.ijcard.2006.11.117] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2006] [Accepted: 11/12/2006] [Indexed: 12/21/2022]
Abstract
BACKGROUND Coronary cameral fistulas (CCF) are an uncommon clinical entity; encountered occasionally during cardiac catheterization. These fistulas most commonly result from congenital abnormalities leading to neovascularization. Other possible etiologies include trauma during surgery or coronary intervention. These fistulas usually terminate directly in a cardiac chamber, most often in the right ventricle. CASE PRESENTATION We describe two cases of CCF where a previous coronary angiogram did not show the presence of the abnormality. Cardiac catheterization in our first patient revealed the presence of a fistula from the right coronary artery draining into the right ventricle. A coronary angiogram performed three years prior to this procedure revealed no obstructive coronary artery disease and no evidence of this fistula. In contrast our second case had an aortic valve replacement for severe aortic stenosis. A cardiac catheterization prior to the surgery revealed normal coronaries with no fistula. The patient's subsequent angiogram three years later revealed the acute marginal branch of the right coronary artery draining into the right atrium. CONCLUSION Coronary cameral fistula is a rare clinical entity and can be acquired during an individual's lifetime. The puzzling presentation in our first patient is unique because CCF was acquired despite lack of previous instrumentation or trauma to the right coronary artery. The exact mechanism of fistula formation is unknown. However a possible hypothesis is secondary to hypoxia-induced angiogenesis, which has not been described to date.
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Leeper NJ, Gupta A, Murphy DJ, Wu JC. Right coronary cameral fistula resulting from surgery of double chamber right ventricle. J Am Soc Echocardiogr 2006; 19:1191.e9-11. [PMID: 16950481 DOI: 10.1016/j.echo.2006.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2006] [Indexed: 11/21/2022]
Affiliation(s)
- Nicholas J Leeper
- Department of Medicine, Division of Cardiology, Stanford School of Medicine, Stanford, California 94305-5344, USA
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Abstract
Background Coronary cameral fistulas are an uncommon entity, the etiology of which may be congenital or traumatic. They involve abnormal termination of a coronary artery, usually the right coronary, into a cardiac chamber, usually the right ventricle. Case Presentation We describe a case of female patient with severe aortic stenosis and interventricular septal hypertrophy that underwent bioprosthetic aortic valve replacement with concomitant septal myectomy. On subsequent follow-up an abnormal flow traversing the septum into the left ventricle was identified and Doppler interrogation demonstrated a continuous flow, with a predominantly diastolic component, consistent with coronary arterial flow. Conclusion The literature on coronary cameral fistulas is reviewed and the etiology of the diagnostic findings discussed. In our patient, a coronary artery to left ventricle fistula was the most likely explanation secondary to trauma to the septal perforator artery during myectomy. Since the patient was asymptomatic at the time of diagnosis no intervention was recommended and has done well on follow-up.
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Affiliation(s)
- Angel López-Candales
- Cardiovascular Institute at the University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Vivek Kumar
- Cardiovascular Institute at the University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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