• Humans
• Coronary Artery Disease/diagnosis

•

Traumatic coronary artery-cameral fistula (TCAF) is rare after blunt chest trauma.

Blunt cardiac trauma covers a spectrum of injuries from clinically insignificant myocardial contusions to lethal ruptures of cardiac valves and chambers. Traumatic coronary artery-cameral fistulas (TCAF) are a rare sequelae of blunt chest trauma.

A 53-year-old male developed a TCAF after a motor vehicle collision. He was found on admission to be in cardiogenic shock with an elevated troponin and intermittent bifascicular block. An echocardiogram revealed hypokinesis of the mid-anteroseptal myocardium with an ejection fraction of 50%. Cardiac catheterization revealed a pseudoaneurysm of the left anterior descending artery (LAD) with a fistulous connection to the right ventricle, shown to be associated with reversible anterior wall ischemia from distal LAD coronary steal phenomenon on a nuclear perfusion scan. Given the ischemic burden, he was treated with operative revascularization via a single vessel coronary artery bypass graft (CABG) using the left internal mammary artery to LAD.

Early repair of TCAF can halt the progression of complications like left-to-right shunting, pulmonary hypertension, and heart failure. The two best described operative approaches to surgical closure of the fistula are either via external ligation or direct repair from within the recipient chamber, possibly with bypass grafting distal to the fistula site. Transcatheter closure and conservative management has been described for select patients with iatrogenic fistulas in recent literature.

High levels of clinical suspicion are necessary for the early detection and intervention of TCAF. Surgical or transcatheter interventions including fistula ligation and CABG can prevent later complications of heart failure.

Introduction. Coronary artery fistulae (CAF) are rare defects with abnormal communication between a coronary artery with either a cardiac chamber or another vascular structure, bypassing the myocardial capillary network. We report a rare multiple arterial coronary fistulae with drainage to the right pulmonary artery. Case Presentation. A 56-year-old male was brought to our hospital for work-up of severe aortic stenosis. Further evaluation revealed multiple CAF with abnormal drainage to the right pulmonary artery. He was discharged after aortic valve replacement and closure of the coronary fistula. Conclusion. This case demonstrates that patients with complex CAF and drainage to the right pulmonary artery can remain asymptomatic and diagnosed accidentally during cardiac imaging, presenting particular challenges in both medical and surgical treatment.

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.

• Acquired coronary-cameral fistulas
• Accidental coronary-cameral fistulas
• Iatrogenic coronary-cameral fistulas
• Spontaneous coronary-cameral fistulas
• Coronary angiography, Spontaneous resolution
• Surgical treatment

This is a case report of a 61-year-old female presenting with ongoing chest pain in the setting of an NSTEMI with lateral ST-T changes. On attempting to open the left circumflex (LCX), it resulted in a proximal LCX dissection. The patient remained stable with no further chest pain. She was treated with IV Eptifibatide for 48 hours and restudied in 72 hours. Repeat coronary angiography showed a marginally improved proximal dissection plane with a coronary AV fistula. She was managed conservatively and discharged with a non-invasive assessment in 8 weeks. The patient had a negative stress echocardiogram and was managed with maximal medical therapy.

• Congenital heart disease
• Coronary artery anomaly
• Coronary artery fistula
• Right coronary artery fistula

• Accidents, Traffic
• Adolescent
• Aortic Dissection/etiology
• Aortic Dissection/pathology
• Aortic Dissection/surgery
• Aortic Dissection/therapy
• Aortic Aneurysm, Thoracic/etiology
• Aortic Aneurysm, Thoracic/pathology
• Aortic Aneurysm, Thoracic/surgery
• Aortic Aneurysm, Thoracic/therapy
• Aortography
• Blood Vessel Prosthesis
• Blood Vessel Prosthesis Implantation/instrumentation
• Cardiac Catheterization
• Coronary Artery Disease/etiology
• Coronary Artery Disease/pathology
• Coronary Artery Disease/therapy
• Echocardiography
• Embolization, Therapeutic
• Heart Ventricles/pathology
• Humans
• Male
• Minimally Invasive Surgical Procedures
• Stents
• Thoracic Injuries/complications
• Thoracic Injuries/pathology
• Thoracic Injuries/therapy
• Tomography, X-Ray Computed
• Treatment Outcome
• Vascular Fistula/etiology
• Vascular Fistula/pathology
• Vascular Fistula/therapy

• Arterio-Arterial Fistula/diagnosis
• Arterio-Arterial Fistula/epidemiology
• Arterio-Arterial Fistula/etiology
• Arterio-Arterial Fistula/therapy
• Arteriovenous Fistula/diagnosis
• Arteriovenous Fistula/epidemiology
• Arteriovenous Fistula/etiology
• Arteriovenous Fistula/therapy
• Coronary Angiography
• Coronary Vessel Anomalies/diagnosis
• Coronary Vessel Anomalies/epidemiology
• Coronary Vessel Anomalies/etiology
• Coronary Vessel Anomalies/therapy
• Coronary Vessels
• Humans
• Incidence
• Pulmonary Artery/abnormalities
• Pulmonary Artery/diagnostic imaging
• Pulmonary Veins/abnormalities
• Pulmonary Veins/diagnostic imaging
• Venae Cavae/abnormalities
• Venae Cavae/diagnostic imaging

• Aortic Valve
• Coronary Angiography
• Coronary Artery Bypass
• Coronary Disease/complications
• Coronary Disease/diagnostic imaging
• Coronary Disease/etiology
• Coronary Disease/therapy
• Coronary Thrombosis/complications
• Coronary Thrombosis/diagnostic imaging
• Coronary Thrombosis/etiology
• Coronary Thrombosis/therapy
• Endocarditis/surgery
• Extracorporeal Membrane Oxygenation
• Heart Transplantation/adverse effects
• Heart Ventricles
• Heart-Assist Devices
• Humans
• Male
• Middle Aged
• Myocardial Infarction/etiology
• Myocardial Infarction/therapy
• Recurrence
• Stents

• Aorta, Thoracic/injuries
• Aorta, Thoracic/surgery
• Biomechanical Phenomena
• Bronchi/injuries
• Bronchi/surgery
• Emergency Medical Services/methods
• Emergency Treatment/methods
• Heart Injuries/etiology
• Heart Injuries/surgery
• Humans
• Incidence
• Thoracic Injuries/complications
• Thoracic Injuries/diagnosis
• Thoracic Injuries/epidemiology
• Thoracic Injuries/surgery
• Thoracic Surgical Procedures/methods
• Thoracic Wall/injuries
• Thoracic Wall/surgery
• Thoracoscopy
• Thoracostomy
• Thoracotomy
• Trachea/injuries
• Trachea/surgery
• Trauma Severity Indices
• Treatment Outcome
• Wounds, Nonpenetrating/complications
• Wounds, Nonpenetrating/diagnosis
• Wounds, Nonpenetrating/epidemiology
• Wounds, Nonpenetrating/surgery