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1
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Mejía HPG, Nogueira MCA, Mioto BM, Poppi NT, Cesar LAM, Sousa LLCM, Dallan LRP. Coronary-Cavitary Fistula, an Unusual Cause of Heart Failure. Arq Bras Cardiol 2025; 122:e20240809. [PMID: 40197940 PMCID: PMC12058156 DOI: 10.36660/abc.20240809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2024] [Revised: 01/15/2025] [Accepted: 01/15/2025] [Indexed: 04/10/2025] Open
Affiliation(s)
- Hernán Patricio García Mejía
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Matheus Carvalho Alves Nogueira
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Bruno Mahler Mioto
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Nilson Tavares Poppi
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Luiz Antonio Machado Cesar
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Luhanda Leonora Cardoso Monti Sousa
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Luís Roberto Palma Dallan
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
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2
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Hakimi M, Kamsheh AM, O'Connor MJ, Loscalzo S. Case 3: Shock after Gluteal Abscess Incision and Drainage in a 15-month-old Girl. Pediatr Rev 2024; 45:1-5. [PMID: 39349859 DOI: 10.1542/pir.2023-006019] [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: 02/13/2023] [Revised: 04/10/2023] [Accepted: 04/14/2023] [Indexed: 11/01/2024]
Affiliation(s)
| | | | | | - Steven Loscalzo
- Division of Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
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3
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Hasuwa K, Uemura H, Kondo T, Kasuda S. Sudden infantile death due to left ventricular myocardial ischemia associated with undiagnosed single coronary artery of Lipton's type LII-B. J Forensic Leg Med 2024; 107:102738. [PMID: 39213904 DOI: 10.1016/j.jflm.2024.102738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 08/23/2024] [Accepted: 08/24/2024] [Indexed: 09/04/2024]
Abstract
Single coronary artery (SCA) is a rare malformation, particularly in isolation without other congenital heart defects. Here, we describe a case of sudden infantile death due to myocardial ischemia associated with undiagnosed SCA. A 1-year-and-7-month-old female infant died suddenly after vomiting at home. A medicolegal autopsy revealed that the orifice of the right coronary artery (RCA) was absent. As expected, the left coronary artery was detached from the left coronary sinus; however, the ostium was covered with a flap-like fibrous ridge. The thin RCA originated from the left main trunk (LMT) and passed between the aorta and pulmonary artery trunk. The left circumflex artery branched from the LMT at a right angle. Judging from the origin and course of the anomalous RCA, the deceased was diagnosed with SCA of Lipton's type LII-B. Microscopic examination revealed ischemic changes around the endocardium of the lateral wall of the left ventricle (LV) rather than on the side of the abnormal RCA. This evoked attention, as there appeared to be some discrepancy. To the best of our knowledge, this is the first case report describing sudden infantile death related to LV myocardial ischemia associated with undiagnosed SCA of Lipton's type LⅡ-B.
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Affiliation(s)
- Kyoko Hasuwa
- Department of Legal Medicine, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8521, Japan
| | - Hideki Uemura
- Fujimidai-dori Clinic, Nerima, 3rd floor, 3-2-5, Nukui, Nerima, Tokyo, 176-0021, Japan
| | - Takeshi Kondo
- Division of Legal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunokicho, Chuo, Kobe, 650-0017, Japan
| | - Shogo Kasuda
- Department of Legal Medicine, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8521, Japan.
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4
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Zergoune N, Benabdellah M, Hara L, Ech-Chenbouli A, Raissouni Z. Stable angina revealing a post-traumatic coronary cameral fistula: A case report. Radiol Case Rep 2024; 19:3522-3524. [PMID: 38881622 PMCID: PMC11179562 DOI: 10.1016/j.radcr.2024.05.037] [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: 05/04/2024] [Accepted: 05/13/2024] [Indexed: 06/18/2024] Open
Abstract
Coronary-cameral fistulas are abnormal connections between coronary arteries and any of the heart chambers, It may be acquired or congenital (whether isolated or along with congenital heart diseases); It is usually asymptomatic in younger patients; but with increasing age, symptoms begin to appear, and the incidence of complication rises. Coronary angiography is the gold standard in diagnosis but echography and cardiac magnetic resonance imaging may be also useful. It can be treated medically with β-blockers or calcium channel blockers, but large fistulas with hemodynamic significant shunts should be closed by transcatheter or surgical means. We present a 57-year-old patient with a history of chest trauma, that present fistulas connecting the 3 coronary arteries to the left ventricle chamber complicated by myocardial ischemia causing stable angina.
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Affiliation(s)
- Nabil Zergoune
- University Hospital Mohamed VI, Cardiology Department, Abdelmalek Essadi University, Tangier, Morocco
| | - Malak Benabdellah
- University Hospital Mohamed VI, Cardiology Department, Abdelmalek Essadi University, Tangier, Morocco
| | - Loubna Hara
- University Hospital Mohamed VI, Cardiology Department, Abdelmalek Essadi University, Tangier, Morocco
| | - Amine Ech-Chenbouli
- University Hospital Mohamed VI, Cardiology Department, Abdelmalek Essadi University, Tangier, Morocco
| | - Zainab Raissouni
- University Hospital Mohamed VI, Cardiology Department, Abdelmalek Essadi University, Tangier, Morocco
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5
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Baz RO, Refi D, Scheau C, Savulescu-Fiedler I, Baz RA, Niscoveanu C. Coronary Artery Anomalies: A Computed Tomography Angiography Pictorial Review. J Clin Med 2024; 13:3920. [PMID: 38999486 PMCID: PMC11242126 DOI: 10.3390/jcm13133920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Revised: 06/29/2024] [Accepted: 07/01/2024] [Indexed: 07/14/2024] Open
Abstract
Coronary arteries have a wide range of anatomical variability, and their spectrum ranges from asymptomatic cases to those predisposed to hemodynamic compromise or even sudden cardiac death. This paper aims to review the classification of coronary artery anomalies (CAAs) and illustrate their imaging characteristics by highlighting the important role of CT coronary angiography. Some of the coronary anomalies usually met in current practice are the high origin coronary artery, multiple ostia, aberrant origin from the opposite/non-coronary Valsalva sinus, single coronary artery, ALCAPA syndrome, duplications of the left anterior descending artery, coronary fistulas, and extracardiac terminations. CT coronary angiography is a non-invasive diagnostic modality for CAAs. The complex anatomy of these anomalies can be accurately described by employing 3D reconstructions and post-processing techniques. Knowledge of the imaging characteristics and potential functional impact of these anomalies is essential for accurate diagnosis and therapeutic planning of patients.
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Affiliation(s)
- Radu Octavian Baz
- Clinical Laboratory of Radiology and Medical Imaging, "Sf. Apostol Andrei" County Emergency Hospital, 900591 Constanta, Romania
- Department of Radiology and Medical Imaging, Faculty of Medicine, "Ovidius" University, 900527 Constanta, Romania
| | - Deria Refi
- Clinical Laboratory of Radiology and Medical Imaging, "Sf. Apostol Andrei" County Emergency Hospital, 900591 Constanta, Romania
| | - Cristian Scheau
- Department of Physiology, The "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Radiology and Medical Imaging, "Foisor" Clinical Hospital of Orthopaedics, Traumatology and Osteoarticular TB, 021382 Bucharest, Romania
| | - Ilinca Savulescu-Fiedler
- Department of Internal Medicine, The "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Internal Medicine and Cardiology, Coltea Clinical Hospital, 030167 Bucharest, Romania
| | - Radu Andrei Baz
- Clinical Laboratory of Radiology and Medical Imaging, "Sf. Apostol Andrei" County Emergency Hospital, 900591 Constanta, Romania
| | - Cosmin Niscoveanu
- Clinical Laboratory of Radiology and Medical Imaging, "Sf. Apostol Andrei" County Emergency Hospital, 900591 Constanta, Romania
- Department of Radiology and Medical Imaging, Faculty of Medicine, "Ovidius" University, 900527 Constanta, Romania
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6
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Yan W, He Z, Luo Y, Huang W, Zhu B, Zhong Y, Wang X. Prevalence and characteristics of coronary artery fistulas among 20 259 patients undergoing invasive coronary angiography. Coron Artery Dis 2024; 35:135-142. [PMID: 38206811 DOI: 10.1097/mca.0000000000001327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
BACKGROUND Coronary artery fistula (CAF) is a rare coronary anomaly. This study aimed to investigate the prevalence, clinical features, and imaging characteristics of CAF among patients undergoing coronary angiography (CAG). METHOD This was a retrospective study including 20 259 consecutive patients (12 458 were male) who underwent CAG at our institution from September 2018 to March 2023. Electronic angiography records were reviewed, and a total of 86 (0.42%) CAF patients were enrolled and analyzed. RESULT Of the 86 CAF patients, 42 (49%) were male. Thus, the prevalence of CAF for males and females was 0.34% and 0.56%, respectively. Arrhythmia, left ventricular (LV) hypertrophy, LV dilation, and LV systolic dysfunction were observed in 38, 25, 10 and 5 cases, respectively. Among the 86 CAF patients, a total of 117 CAFs were detected. 61 (71%) patients had a single CAF, and the remaining 25 (29%) patients had multiple CAFs. Of the 117 CAFs, the most common origins and terminations were the left anterior descending artery (n = 50) and the pulmonary artery (n = 73), respectively. The CAF diameters were greatly varied, ranging from unmeasurable to 7.8 mm, and 22 (18%) CAFs were larger than 3 mm. CONCLUSION In the present study, the prevalence of CAF was 0.42% with a female predilection. Arrhythmia, LV remodeling and dysfunction were common. Seventy-one percent of patients had a single CAF. The left anterior descending artery and the pulmonary artery were the most common origin and termination of CAFs, respectively. Most CAFs were small, and 18% of CAFs were larger than 3 mm.
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Affiliation(s)
- Wei Yan
- Department of Cardiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
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7
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Song Y, Choi ES, Kim DH, Kwon BS, Park CS, Yun TJ. Surgical Management of Coronary Artery Fistulas in Children. J Chest Surg 2024; 57:79-86. [PMID: 38174894 DOI: 10.5090/jcs.23.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/16/2023] [Accepted: 11/10/2023] [Indexed: 01/05/2024] Open
Abstract
Background This study investigated the surgical outcomes associated with coronary artery fistulas (CAFs) in children. Methods We retrospectively reviewed the medical records of 23 pediatric patients who underwent surgical closure of CAFs between 1995 and 2021. At presentation, 7 patients (30.4%) exhibited symptoms. Associated cardiac anomalies were present in 8 patients. Fourteen fistulas originated from the right coronary artery and 9 from the left. The most common drainage site was the right ventricle, followed by the right atrium and the left ventricle. The median follow-up duration was 9.3 years (range, 0.1-25.6 years). Results The median age and body weight at repair were 3.1 years (range, 0-13.4 years) and 14.4 kg (range, 3.1-42.2 kg), respectively. Cardiopulmonary bypass was used in 17 cases (73.9%), while cardioplegic arrest was employed in 14 (60.9%). Epicardial CAF ligation was utilized in 10 patients (43.5%), the transcoronary approach in 9 (39.1%), the endocardial approach in 2 (8.7%), and other methods in 2 patients (8.7%). The application of cardioplegic arrest during repair did not significantly impact the duration of postoperative intensive care unit stay or overall hospital stay. One in-hospital death and 1 late death were recorded. The overall survival rate was 95.7% at 10 years and 83.7% at 15 years. A residual fistula was detected in 1 patient. During the follow-up period, no surviving patient experienced cardiovascular symptoms or coronary events. Conclusion Surgical repair of CAF can be performed safely with or without cardioplegic arrest, and it is associated with a favorable prognosis in children.
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Affiliation(s)
- Youngkwan Song
- Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Seok Choi
- Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Hee Kim
- Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Bo Sang Kwon
- Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chun Soo Park
- Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Jin Yun
- Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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8
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Moges T, Ahmed H, Gisila A. Large cameral coronary artery fistula in a 5 months old infant with unusual presentation and fatal outcome: -case report. BMC Pediatr 2023; 23:385. [PMID: 37543567 PMCID: PMC10403903 DOI: 10.1186/s12887-023-04196-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/18/2023] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND Congenital coronary fistulas (CAFs) are uncommon abnormalities communicating the coronary arteries with the cardiac chambers or portion of the systemic or pulmonary circulation. Over 90% of the cases drain into the right side of the heart with only 3% terminating in the left ventricle. Infants with a large CAFs may develop congestive heart failure. CASE PRESENTATION A 5 months old female infant presented with labored breathing and worsening of bluish discoloration of the lips and extremities following a prolonged cry. She had a history of breastfeeding difficulty and noticeable bluish discoloration of the lips and extremities since birth. The infant was wasted and had a fast heart rate, bluish lips, and nail beds with clubbing of fingers and toes. A cardiac murmur was noted during her medical checkup. Chest x-ray showed cardiomegaly. Echocardiography and CT angiography showed large Cameral CAF involving the left main and left anterior descending artery draining into the left ventricle. The tricuspid valve was dysplastic, there was secundum ASD, and VSD with a right to left shunt. The patient developed episode of cyanotic spells after crying excessively following a CT angiographic procedure which culminated in respiratory arrest and her demise. She was managed as a case of hypoxic spells in the ICU before her death. CONCLUSION This report unveiled unfamiliar case of Cameral coronary artery fistula with left-to-left shunting, cyanosis, and dysplastic tricuspid valve.
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Affiliation(s)
- Tamirat Moges
- Department of Pediatrics and Child Health, School of Medicine, College of Health Sciences Addis Ababa University, Addis Ababa, Ethiopia.
| | - Hayat Ahmed
- Department of Pediatrics and Child Health, School of Medicine, College of Health Sciences Addis Ababa University, Addis Ababa, Ethiopia
| | - Azmeraw Gisila
- Department of Radiology School of Medicine, College of Health Sciences Addis Ababa University, Addis Ababa, Ethiopia
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9
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Gong S, Marasco S, Wong M, Hiscock M. Left main coronary artery to pulmonary artery fistula presenting as angina and ventricular tachycardia - A case report and literature review. Clin Case Rep 2023; 11:e7231. [PMID: 37143465 PMCID: PMC10151588 DOI: 10.1002/ccr3.7231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 02/23/2023] [Accepted: 04/04/2023] [Indexed: 05/06/2023] Open
Abstract
Coronary artery fistulae are an uncommon abnormality of the coronary arteries, but when hemodynamically significant can present as angina, dyspnea, and arrhythmia as a rare cause of functional myocardial ischemia via 'coronary steal phenomenon'.
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Affiliation(s)
- Simone Gong
- Department of CardiologyEpworth Hospital RichmondMelbourneVictoriaAustralia
- Department of MedicineUniversity of MelbourneMelbourneVictoriaAustralia
| | - Silvana Marasco
- Department of CardiologyEpworth Hospital RichmondMelbourneVictoriaAustralia
- CJOB Cardiothoracic Surgery DepartmentThe Alfred HospitalMelbourneVictoriaAustralia
- Department of SurgeryMonash UniversityMelbourneVictoriaAustralia
| | - Michael Wong
- Department of CardiologyEpworth Hospital RichmondMelbourneVictoriaAustralia
| | - Martin Hiscock
- Department of CardiologyEpworth Hospital RichmondMelbourneVictoriaAustralia
- Department of MedicineUniversity of MelbourneMelbourneVictoriaAustralia
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Kusano N, Marutani S, Ishimaru K, Sato T, Sugimoto K, Inamura N. Growing Coronary Aneurysm Secondary to Coronary Fistula Despite Decreased Pulmonary Blood Flow/Systemic Blood Flow Ratio in a Child: A Case Report. Pediatr Dev Pathol 2022; 26:133-137. [PMID: 36461892 DOI: 10.1177/10935266221139666] [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: 12/04/2022]
Abstract
Coronary aneurysm secondary to coronary fistula is a rare condition, with no existing report on its pathological examination. We report the case of a patient diagnosed with a right coronary artery fistula with coronary aneurysm during the fetal period. During follow-up after delivery, the aneurysm became larger, even though the shunt size decreased. We were afraid the aneurysm would rupture and therefore, planned elective catheter embolization. At the age of 4 years, the patient underwent surgery, which involved closing the fistula and making the lumen of the aneurysm smaller. However, the surgery was not catheter embolization as planned because segment 3 branched off from the largest aneurysm where we planned to embolize. Pathologically, the structure of the coronary artery differed from that of a healthy one, with thickened intima and media, fewer scattered smooth muscle cells, widely distributed elastic fibers, and mucoid degeneration in the media. The structure of the coronary artery suggested that the vessel wall was weak and that the aneurysm would rupture if not treated. Postoperative coronary angiography showed that segment 2 was obstructed, while the collaterals from the left coronary artery perfused the area. We could have treated the fistula with a catheter as scheduled.
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Affiliation(s)
- Nobuyoshi Kusano
- Department of Pediatrics, Kindai University Faculty of Medicine, Osaka, Japan
| | - Satoshi Marutani
- Department of Pediatrics, Kindai University Faculty of Medicine, Osaka, Japan
| | - Kazuhiko Ishimaru
- Department of Cardiovascular surgery, Kindai University Faculty of Medicine, Osaka, Japan
| | - Takao Sato
- Department of Pathology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Keisuke Sugimoto
- Department of Pediatrics, Kindai University Faculty of Medicine, Osaka, Japan
| | - Noboru Inamura
- Department of Pediatrics, Kindai University Faculty of Medicine, Osaka, Japan
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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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12
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Li W, Liu XD, Liu YQ, Zhuang XD, Wu ZK, Yao FJ. Diagnosis of left anterior descending branch-right ventricular fistula with giant coronary artery aneurysm by contrast echocardiography: A case report. Echocardiography 2022; 39:935-939. [PMID: 35668043 DOI: 10.1111/echo.15399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 04/13/2022] [Accepted: 05/22/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Coronary fistulae are communications between a coronary artery and a heart chamber or vessel. The final diagnosis is usually made by coronary angiography or computed tomographic (CT) angiography. Here we report a case by employing contrast echocardiography in diagnosis of a giant coronary aneurysm with right ventricle (RV) fistula. CASE PRESENTATION The patient, a 29-year-old woman, referred to our institution with a complaint of palpitation occasionally. Transthoracic echocardiogram showed a spherical, echogenic structure in the apex of RV. Proximal to the aneurysm, the left anterior descending branch (LAD) remained enlarged (8-9 mm) and showed a fistulous communication with the echogenic structure. A contrast echocardiography was performed, and 4-5 cardiac cycle after the left ventricle was enhanced, the echogenic structure started to become more prominent and several fistulae were seen between RV and the echogenic structure. Computed tomography (CT) angiography and coronary angiography confirmed the dilation (9 mm in diameter) of the LAD with an aneurysm at the distal segment of the LAD, with a small amount of iodinated contrast agent flowing into the subsequent region of the RV, thereby characterizing a LAD-to-RV fistula. CONCLUSION The final diagnosis of fistula is usually made by coronary angiography or CT angiography. However, contrast echocardiography is also a well-established method for the demonstration of intracardiac shunting. In this case, the contrast echocardiography clearly revealed one of the fistulae between the aneurysm and RV.
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Affiliation(s)
- Wei Li
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Xian-du Liu
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Yan-Qiu Liu
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Xiao-Dong Zhuang
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zhong-Kai Wu
- Second Department of Cardiac Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Feng-Juan Yao
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
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Ranjan P, Ro R, Lerakis S. Multislice Computed Tomography (MSCT) and Cardiovascular Magnetic Resonance (CMR) Imaging for Coronary and Structural Heart Disease. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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14
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Multiple Coronary Fistulas as a Rare Cause of Stable Angina Pectoris. Case Rep Cardiol 2022; 2022:9372295. [PMID: 35280942 PMCID: PMC8916878 DOI: 10.1155/2022/9372295] [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: 05/01/2021] [Revised: 01/27/2022] [Accepted: 02/23/2022] [Indexed: 11/18/2022] Open
Abstract
Congenital coronary artery-left ventricular multiple microfistulas (CA-LVMMFs) are rare anomalies in adults. They are more often found in female patients, and they usually originate from the distal segments of the coronary arteries, but they can originate from a proximal segments of a coronary arteries, and these patients are likely to be identified and treated in the pediatric age group. They are mostly asymptomatic. When symptoms and complications occur, they include angina, myocardial infarction, atrial heart failure, arrhythmias, and endocarditis. The management of CA-LVMMFs is controversial, but it is generally agreed that conservative medical management is the primary treatment of choice. Our case describes a rare form of CA-LVMMFs draining into the left ventricle in a female patient presenting with fatigue, atypical anginal symptoms, atrial fibrillation, and premature ventricular complexes, without concomitant obstructive coronary artery disease.
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Tzimas G, Gulsin GS, Takagi H, Mileva N, Sonck J, Muller O, Leipsic JA, Collet C. Coronary CT Angiography to Guide Percutaneous Coronary Intervention. Radiol Cardiothorac Imaging 2022; 4:e210171. [PMID: 35782760 PMCID: PMC8893214 DOI: 10.1148/ryct.210171] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 11/08/2021] [Accepted: 11/22/2021] [Indexed: 05/03/2023]
Abstract
Coronary CT angiography (CCTA) has emerged as a powerful noninvasive tool for characterizing the presence, extent, and severity of coronary artery disease (CAD) in patients with stable angina. Recent technological advancements in CT scanner hardware and software have augmented the rich information that can be derived from a single CCTA study. Beyond merely identifying the presence of CAD and assessing stenosis severity, CCTA now allows for the identification and characterization of plaques, lesion length, and fluoroscopic angle optimization, as well as enables the assessment of the physiologic extent of stenosis through CT-derived fractional flow reserve, and may even allow for the prediction of the response to revascularization. These and other features make CCTA capable of not only guiding invasive coronary angiography referral, but also give it the unique ability to help plan coronary intervention. This review summarizes current and future applications of CCTA in procedural planning for percutaneous coronary intervention, provides rationale for wider integration of CCTA in the workflow of the interventional cardiologist, and details how CCTA may help improve patient care and clinical outcomes. Keywords: CT Angiography © RSNA, 2022.
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Affiliation(s)
- Georgios Tzimas
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z4 (G.T., G.S.G., H.T.,
J.A.L.); Department of Heart Vessels, Cardiology Service, Lausanne University
Hospital and University of Lausanne, Lausanne, Switzerland (G.T., O.M.);
University of Leicester and the Leicester NIHR Biomedical Research Centre,
Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, England
(G.S.G.); Department of Diagnostic Radiology, Tohoku University Hospital,
Sendai, Japan (H.T.); Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
(N.M., J.S., C.C.); and Department of Advanced Biomedical Sciences, Federico II
University, Naples, Italy (J.S.)
| | - Gaurav S. Gulsin
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z4 (G.T., G.S.G., H.T.,
J.A.L.); Department of Heart Vessels, Cardiology Service, Lausanne University
Hospital and University of Lausanne, Lausanne, Switzerland (G.T., O.M.);
University of Leicester and the Leicester NIHR Biomedical Research Centre,
Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, England
(G.S.G.); Department of Diagnostic Radiology, Tohoku University Hospital,
Sendai, Japan (H.T.); Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
(N.M., J.S., C.C.); and Department of Advanced Biomedical Sciences, Federico II
University, Naples, Italy (J.S.)
| | - Hidenobu Takagi
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z4 (G.T., G.S.G., H.T.,
J.A.L.); Department of Heart Vessels, Cardiology Service, Lausanne University
Hospital and University of Lausanne, Lausanne, Switzerland (G.T., O.M.);
University of Leicester and the Leicester NIHR Biomedical Research Centre,
Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, England
(G.S.G.); Department of Diagnostic Radiology, Tohoku University Hospital,
Sendai, Japan (H.T.); Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
(N.M., J.S., C.C.); and Department of Advanced Biomedical Sciences, Federico II
University, Naples, Italy (J.S.)
| | - Niya Mileva
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z4 (G.T., G.S.G., H.T.,
J.A.L.); Department of Heart Vessels, Cardiology Service, Lausanne University
Hospital and University of Lausanne, Lausanne, Switzerland (G.T., O.M.);
University of Leicester and the Leicester NIHR Biomedical Research Centre,
Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, England
(G.S.G.); Department of Diagnostic Radiology, Tohoku University Hospital,
Sendai, Japan (H.T.); Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
(N.M., J.S., C.C.); and Department of Advanced Biomedical Sciences, Federico II
University, Naples, Italy (J.S.)
| | - Jeroen Sonck
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z4 (G.T., G.S.G., H.T.,
J.A.L.); Department of Heart Vessels, Cardiology Service, Lausanne University
Hospital and University of Lausanne, Lausanne, Switzerland (G.T., O.M.);
University of Leicester and the Leicester NIHR Biomedical Research Centre,
Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, England
(G.S.G.); Department of Diagnostic Radiology, Tohoku University Hospital,
Sendai, Japan (H.T.); Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
(N.M., J.S., C.C.); and Department of Advanced Biomedical Sciences, Federico II
University, Naples, Italy (J.S.)
| | - Olivier Muller
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z4 (G.T., G.S.G., H.T.,
J.A.L.); Department of Heart Vessels, Cardiology Service, Lausanne University
Hospital and University of Lausanne, Lausanne, Switzerland (G.T., O.M.);
University of Leicester and the Leicester NIHR Biomedical Research Centre,
Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, England
(G.S.G.); Department of Diagnostic Radiology, Tohoku University Hospital,
Sendai, Japan (H.T.); Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
(N.M., J.S., C.C.); and Department of Advanced Biomedical Sciences, Federico II
University, Naples, Italy (J.S.)
| | - Jonathon A. Leipsic
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z4 (G.T., G.S.G., H.T.,
J.A.L.); Department of Heart Vessels, Cardiology Service, Lausanne University
Hospital and University of Lausanne, Lausanne, Switzerland (G.T., O.M.);
University of Leicester and the Leicester NIHR Biomedical Research Centre,
Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, England
(G.S.G.); Department of Diagnostic Radiology, Tohoku University Hospital,
Sendai, Japan (H.T.); Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
(N.M., J.S., C.C.); and Department of Advanced Biomedical Sciences, Federico II
University, Naples, Italy (J.S.)
| | - Carlos Collet
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z4 (G.T., G.S.G., H.T.,
J.A.L.); Department of Heart Vessels, Cardiology Service, Lausanne University
Hospital and University of Lausanne, Lausanne, Switzerland (G.T., O.M.);
University of Leicester and the Leicester NIHR Biomedical Research Centre,
Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, England
(G.S.G.); Department of Diagnostic Radiology, Tohoku University Hospital,
Sendai, Japan (H.T.); Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
(N.M., J.S., C.C.); and Department of Advanced Biomedical Sciences, Federico II
University, Naples, Italy (J.S.)
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16
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Park J, Park B, Kang EJ, Lee J. CT Imaging Findings in Non-Atherosclerotic Coronary Artery Disease. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:70-83. [PMID: 36237354 PMCID: PMC9238194 DOI: 10.3348/jksr.2021.0165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/13/2021] [Accepted: 01/07/2022] [Indexed: 11/24/2022]
Abstract
급성 관동맥 증후군(acute coronary syndrome)은 대부분 죽상경화 관상동맥 질환(atherosclerotic coronary artery disease)에 의해 발생하지만, 비죽상경화 관상동맥 질환에서도 발생할 수 있다. 고식적 관상동맥 혈관조영술은 동맥 내강의 협착이나 확장 등의 형상에 대한 정보만을 제공하고, 동맥경화반이나 동맥벽에 대한 평가가 어려워 관상동맥 이상의 원인 질환의 진단에 낮은 특이도를 보인다. 반면, 관상동맥 전산화단층촬영 혈관조영술은 혈관경화반의 특징, 혈관벽의 조영증강뿐 아니라 연접한 대동맥이나 폐동맥의 변화 등도 함께 관찰할 수 있어, 비죽상경화 관상상동맥질환의 진단 및 다양한 원인 감별에 도움이 된다. 따라서 이 종설에서는 다양한 비죽상경화 관상동맥 질환들을 소개하고, 이의 병태생리 및 대표적인 관상동맥 전산화단층촬영 혈관조영술의 영상 소견에 대해 설명하고자 한다.
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Affiliation(s)
- Jongmin Park
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Byunggeon Park
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Eun-Ju Kang
- Department of Radiology, Dong-A University Medical Center, Dong-A University College of Medicine, Busan, Korea
| | - Jongmin Lee
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Korea
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17
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Bansal A, Sarkar PG, Gupta MD, Girish MP, Kunal S, Batra V, Yusuf J, Safal, Mukhopadhyay S, Tyagi S. Prevalence and patterns of coronary artery anomalies in 28,800 adult patients undergoing angiography in a large tertiary care centre in India. Monaldi Arch Chest Dis 2021; 92. [PMID: 34918500 DOI: 10.4081/monaldi.2021.2066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 12/16/2021] [Indexed: 11/22/2022] Open
Abstract
Coronary artery anomalies (CAAs) are a diverse group of disorders with varied clinical presentation and pathophysiological mechanisms. A majority of these anomalies are asymptomatic and often an incidental finding on coronary angiogram or autopsy. This retrospective study included 28,800 patients who underwent coronary angiography from 2016 to 2020. The coronary angiograms were reviewed by two independent reviewers and CAAs were documented. CAAs were classified into (a) anomalies of coronary artery connection, (b) anomalies of intrinsic coronary arterial anatomy and (c) anomalies of myocardial/coronary artery interaction as proposed by the European Society of Cardiology. Of the 28,800 coronary angiograms, CAAs were present in 4.12% with anomalies in the left coronary artery (LCA) being most common. Anomalies of coronary artery connection were most common (48.48%) followed by anomalies of myocardial/coronary artery interaction (34.49%) and anomalies of intrinsic coronary artery anatomy (17.03%). Among anomalies of coronary artery connection, absent left main trunk or split LCA with separate origins of left anterior descending coronary artery and left circumflex coronary artery from the left coronary sinus of Valsalva (22.59%) was most common. An intramural course or "myocardial bridge" had an incidence of 1.16% while incidence of coronary artery fistulae (CAF) was 0.115%.
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Affiliation(s)
- Ankit Bansal
- Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi.
| | - Prattay Guha Sarkar
- Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi.
| | - Mohit D Gupta
- Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi.
| | - M P Girish
- Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi.
| | - Shekhar Kunal
- Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi.
| | - Vishal Batra
- Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi.
| | - Jamal Yusuf
- Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi.
| | - Safal
- Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi.
| | - Saibal Mukhopadhyay
- Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi.
| | - Sanjay Tyagi
- Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi.
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18
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Thangathurai J, Kalashnikova M, Takahashi M, Shinbane JS. Coronary Artery Aneurysm in Kawasaki Disease: Coronary CT Angiography through the Lens of Pathophysiology and Differential Diagnosis. Radiol Cardiothorac Imaging 2021; 3:e200550. [PMID: 34778780 DOI: 10.1148/ryct.2021200550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 07/21/2021] [Accepted: 09/13/2021] [Indexed: 12/17/2022]
Abstract
Kawasaki disease (KD) is an inflammatory autoimmune vasculitis affecting the coronary arteries of very young patients, which can result in coronary artery aneurysms (CAAs) with lifelong manifestations. Accurate identification and assessment of CAAs in the acute phase and sequentially during the chronic phase of KD is fundamental to the treatment plan for these patients. The differential diagnosis of CAA includes atherosclerosis, other vasculitic processes, connective tissue disorders, fistulas, mycotic aneurysms, and procedural sequelae. Understanding of the initial pathophysiology and evolutionary arterial changes is important to interpretation of imaging findings. There are multiple applicable imaging modalities, each with its own strengths, limitations, and role at various stages of the disease process. Coronary CT angiography is useful for evaluation of CAAs as it provides assessment of the entire coronary tree, CAA size, structure, wall, and lumen characteristics and visualization of other cardiothoracic vasculature. Knowledge of the natural history of KD, the spectrum of other conditions that can cause CAA, and the strengths and limitations of cardiovascular imaging are all important factors in imaging decisions and interpretation. Keywords: Pediatrics, Coronary Arteries, Angiography, Cardiac © RSNA, 2021.
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Affiliation(s)
- Jenica Thangathurai
- Department of Medicine, Division of Cardiology, Harbor-University of California, Los Angeles Medical Center, 1124 W Carson St, RB-2 3rd Floor, Torrance, CA 90502 (J.T.); Department of Medicine, Brigham and Women's Hospital and Harvard School of Medicine, Boston, Mass (M.K.); Department of Pediatrics, University of Washington School of Medicine and Heart Center, Seattle Children's Hospital, Seattle, Wash (M.T.); and Division of Cardiovascular Medicine, Keck School of Medicine of the University of Southern California, Health Science Campus, Los Angeles, Calif (J.S.S.)
| | - Mariya Kalashnikova
- Department of Medicine, Division of Cardiology, Harbor-University of California, Los Angeles Medical Center, 1124 W Carson St, RB-2 3rd Floor, Torrance, CA 90502 (J.T.); Department of Medicine, Brigham and Women's Hospital and Harvard School of Medicine, Boston, Mass (M.K.); Department of Pediatrics, University of Washington School of Medicine and Heart Center, Seattle Children's Hospital, Seattle, Wash (M.T.); and Division of Cardiovascular Medicine, Keck School of Medicine of the University of Southern California, Health Science Campus, Los Angeles, Calif (J.S.S.)
| | - Masato Takahashi
- Department of Medicine, Division of Cardiology, Harbor-University of California, Los Angeles Medical Center, 1124 W Carson St, RB-2 3rd Floor, Torrance, CA 90502 (J.T.); Department of Medicine, Brigham and Women's Hospital and Harvard School of Medicine, Boston, Mass (M.K.); Department of Pediatrics, University of Washington School of Medicine and Heart Center, Seattle Children's Hospital, Seattle, Wash (M.T.); and Division of Cardiovascular Medicine, Keck School of Medicine of the University of Southern California, Health Science Campus, Los Angeles, Calif (J.S.S.)
| | - Jerold S Shinbane
- Department of Medicine, Division of Cardiology, Harbor-University of California, Los Angeles Medical Center, 1124 W Carson St, RB-2 3rd Floor, Torrance, CA 90502 (J.T.); Department of Medicine, Brigham and Women's Hospital and Harvard School of Medicine, Boston, Mass (M.K.); Department of Pediatrics, University of Washington School of Medicine and Heart Center, Seattle Children's Hospital, Seattle, Wash (M.T.); and Division of Cardiovascular Medicine, Keck School of Medicine of the University of Southern California, Health Science Campus, Los Angeles, Calif (J.S.S.)
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19
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Romero-Castro MJ, Unzué L, García E, Fernández-Friera L. Case report of an acute coronary syndrome in a patient with artery coronary fistulae. Eur Heart J Case Rep 2021; 5:ytab323. [PMID: 34859178 PMCID: PMC8634293 DOI: 10.1093/ehjcr/ytab323] [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: 01/02/2021] [Revised: 02/23/2021] [Accepted: 07/26/2021] [Indexed: 11/12/2022]
Abstract
Background Coronary artery fistulae are rare vascular anomalies. Although they are usually asymptomatic, the presence of symptoms might present a challenge in the diagnostic and therapeutic management. Case summary We present a patient with chest pain whose initial tests were normal, but coronary artery fistulae were found. Single-photon emission computed tomography test showed ischaemia due to coronary artery fistulae and cardiac computed tomography helped in the planning of the percutaneous closure. Discussion CCT is emerging as an optimal non-invasive tool to characterise the morphology and course of coronary artery fistulae and may be essential for its accurate diagnosis and planning for percutaneous closure.
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Affiliation(s)
- María José Romero-Castro
- Cardiac Imaging Unit, Cardiology Department, HM Hospitales-Centro Integral de Enfermedades Cardiovasculares HM CIEC, Avenida de Montepríncipe, Boadilla del Monte, 28660 Madrid, Spain
| | - Leire Unzué
- Interventional Cardiology Department, Hospital Universitario HM Montepríncipe, Madrid, Spain
| | - Eulogio García
- Interventional Cardiology Department, Hospital Universitario HM Montepríncipe, Madrid, Spain
| | - Leticia Fernández-Friera
- Cardiac Imaging Unit, Cardiology Department, HM Hospitales-Centro Integral de Enfermedades Cardiovasculares HM CIEC, Avenida de Montepríncipe, Boadilla del Monte, 28660 Madrid, Spain
- Cardiology Department, HM Hospitales-Centro Integral de Enfermedades Cardiovasculares HM CIEC, Avenida de Montepríncipe, Boadilla del Monte, 28660 Madrid, Spain
- Universidad CEU San Pablo, Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
- CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain
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20
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Witte LS, Bouma BJ, Straver B, van der Lienden BTG, Kist R, Blom NA, Koolbergen DR, de Winter RJ. Closing a Right Coronary Artery Fistula Draining Into the Coronary Sinus Using a Covered Stent in the Coronary Sinus. JACC Case Rep 2021; 3:1589-1593. [PMID: 34729507 PMCID: PMC8543131 DOI: 10.1016/j.jaccas.2021.06.009] [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: 04/16/2021] [Revised: 06/02/2021] [Accepted: 06/07/2021] [Indexed: 11/25/2022]
Abstract
This report describes the case of a symptomatic patient with a right coronary artery fistula draining into the coronary sinus who underwent transcatheter closure, which was deployed in the drainage site to seal off the exit of the fistula. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Lars S Witte
- Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Berto J Bouma
- Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Bart Straver
- Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands.,Department of Pediatric Cardiology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | | | - Rudolf Kist
- Department of Cardiology, Rode Kruis Hospital, Beverwijk, the Netherlands
| | - Nico A Blom
- Department of Pediatric Cardiology, Amsterdam University Medical Centers, Amsterdam, the Netherlands.,Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - David R Koolbergen
- Department of Cardiothoracic Surgery, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Robbert J de Winter
- Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
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21
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Siripornpitak S, Sriprachyakul A, Promphan W, Mokarapong P, Wanitkun S. Coronary artery changes in congenital coronary-cameral fistulas evaluated by computed tomographic angiography. Jpn J Radiol 2021; 39:1149-1158. [PMID: 34181176 DOI: 10.1007/s11604-021-01164-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/21/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE The study sought to determine coronary artery diameter in congenital coronary-cameral fistula (cCCF), factors associated with coronary artery aneurysm, coronary artery changes after fistula closure, and computed tomographic (CT) findings after treatment. MATERIALS AND METHODS We retrospectively reviewed CT findings of the cCCF for origins, terminations, fistula length, complexities, and Sakakibara classification. Coronary artery diameter was expressed as coronary artery Z score. Fistula features associated with coronary artery aneurysm were analyzed. Post-fistula closures were analyzed for coronary artery dilatation, coronary thrombosis, complete fistula closure, and fistula thrombosis. RESULTS Twenty-five patients (median age 33 months, interquartile range, IQR 25-48) were included. Coronary feeders and terminations were frequently right coronary artery (48%) and right ventricle (56%), respectively. Fistula aneurysm occurred in 52% of cases. Mean coronary artery Z score was 13.03 ± 6.36 with a high incidence of giant coronary artery aneurysm (68%). We found no statistically significant risk factors associated with coronary artery aneurysm (p value range 0.075-0.370). Median duration of the follow-up CT after closure of the fistulas was 6.4 months (IQR 5.0-8.7). Coronary artery Z score significantly decreased by 0.82 (IQR 0.28-1.35), p = 0.006 and coronary thrombosis occurred in 23% of cases during follow-up. CONCLUSIONS Large coronary aneurysm is common in cCCF. No characteristic feature of the fistula influencing coronary artery aneurysm is identified. There is a diminution in coronary artery Z score after fistula closure. Coronary thrombosis is a major complication after treatment.
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Affiliation(s)
- Suvipaporn Siripornpitak
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Phayatai, Ratchathewi, Bangkok, 10400, Thailand. .,Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, 270 Rama 6 Road, Phayatai, Ratchathewi, Bangkok, 10400, Thailand.
| | - Apichaya Sriprachyakul
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Phayatai, Ratchathewi, Bangkok, 10400, Thailand.,Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, 270 Rama 6 Road, Phayatai, Ratchathewi, Bangkok, 10400, Thailand
| | - Worakan Promphan
- Department of Pediatrics, Queen Sirikit National Institute of Child Health, Rangsit University, 420/8 Phayatai Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Pirapat Mokarapong
- Cardiovascular and Thoracic Surgery Unit, Department of Surgery, Institute of Cardiovascular Diseases, Rajavithi Hospital, 2 Phayatai Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Suthep Wanitkun
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Phayatai, Ratchathewi, Bangkok, 10400, Thailand.,Division of Cardiology, Department of Pediatrics, Mahidol University, 270 Rama 6 Road, Phayatai, Ratchathewi, Bangkok, 10400, Thailand
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22
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Diab KA, Boujemline Y, Hijazi ZM. Update on shunt closure in neonates and infants. Expert Rev Cardiovasc Ther 2021; 19:475-492. [PMID: 33899641 DOI: 10.1080/14779072.2021.1922079] [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: 10/21/2022]
Abstract
Introduction: Cardiac defects that result in shunting are the most common types of congenital heart anomalies. Although these lesions can be simple, they can cause significant hemodynamic changes and can be challenging to manage in neonates and infants. Over the recent decades, the development of new transcatheter techniques and devices has made it safe and feasible to manage such defects when indicated, even in the smallest of patients. Understanding these interventional procedures is essential in order to manage those patients.Areas covered: In this article, we review the techniques and experience for closure of atrial septal defects, ventricular septal defects, patent ductus aarteriosus,as well as coronary arteriovenous malformations and fistulas in neonates and infants. Literature review of PubMed articles was performed through January 2021, with focus on the latest data and results of the usage of interventional techniques in treating these lesions specifically in this age-group.Expert opinion: Significant shunting lesions can be particularly challenging to manage in neonates and infants. Newer lower profile devices will likely continue to be developed in the future, allowing their use for transcatheter interventions in even smaller patients and those with more complex anatomy.
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Affiliation(s)
- Karim A Diab
- Department of Pediatrics, Sidra Heart Center, Sidra Medicine, Doha, Qatar
| | - Younes Boujemline
- Department of Pediatrics, Sidra Heart Center, Sidra Medicine, Doha, Qatar
| | - Ziyad M Hijazi
- Department of Pediatrics, Sidra Heart Center, Sidra Medicine, Doha, Qatar.,Weill Cornell Medical College, Doha, Qatar.,Weill Cornell Medical College, New York, NY, USA
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23
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Lee KY, Chang K, Lee JM, Lee SW. Interpretation of coronary steal syndrome and haemodynamic changes after surgical closure of coronary fistula using Doppler wire and computational fluid dynamics analysis: a case report. Eur Heart J Case Rep 2021; 5:ytab069. [PMID: 34124543 PMCID: PMC8188863 DOI: 10.1093/ehjcr/ytab069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/22/2020] [Accepted: 02/05/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Coronary arteriovenous fistulas (CAFs) are rare but can cause myocardial ischaemia and other complications. However, the haemodynamic and physiologic characteristics of significant CAFs requiring treatment are poorly described. We report a case of CAF causing coronary steal syndrome in which haemodynamic changes were assessed before and after surgical closure using a Doppler wire and computational fluid dynamics (CFD) technique. CASE SUMMARY A 51-year-old woman presented with exertional chest pain for 3 years. Progressive dyspnoea occurred with exertion. Treadmill and cardiopulmonary exercise tests showed suspicious myocardial ischaemia. Coronary angiography and contrast-enhanced coronary computed tomography angiography (CCTA) revealed a coronary fistula arising from the distal left main coronary artery that drained into the pulmonary artery trunk. We observed a persistent coronary steal phenomenon at baseline and during hyperaemia and a systolic dominant flow rate pattern inside the CAF by Doppler wire-based flow rate measurement. According to CFD analysis based on CCTA, low wall shear stress and a high focal oscillatory shear index were observed at the ostial sites of aneurysmal sacs in the CAF. After successful surgical closure of the CAF, the vessel sizes and flow rate distributions of the coronary arteries increased. DISCUSSION Doppler wire-based flow rate distribution measurements and CFD analysis may facilitate the identification of significant coronary steal syndrome requiring closure and the evaluation of future risks of life-threatening complications such as thrombosis and rupture.
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Affiliation(s)
- Kwan Yong Lee
- Department of Cardiology, Seoul St. Mary’s Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
| | - Kiyuk Chang
- Department of Cardiology, Seoul St. Mary’s Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Ilwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Sang-Wook Lee
- School of Mechanical Engineering, University of Ulsan, 93, Daehak-ro, Nam-gu, Ulsan 44610, Republic of Korea
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24
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Truong T, Nguyen HTT, Phan VTX, Ly MHP, Phan VTT, Phan TA, Phan HH, Tran P. A case report of coronary pulmonary artery fistula detected by transthoracic echocardiography in an elderly patient with dyspnea. AME Case Rep 2021; 5:10. [PMID: 33623864 DOI: 10.21037/acr-20-100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 11/25/2020] [Indexed: 11/06/2022]
Abstract
Coronary pulmonary artery fistula (CPAF) is a rare entity in the population. It may present with multiple clinical settings and in various age ranges. Invasive coronary angiography (ICA), coronary computed tomography angiography (CCTA), and transthoracic echocardiography (TTE) have been reported as diagnostic tools for CPAF. Among them, TTE is rarely capable of identifying CPAF. There is no current treatment guideline as some of the interventional therapies are effective yet controversial. The therapy therefore should be individualized. We report a case of CPAF accidentally detected by TTE in a 93-year-old female who presented with acute respiratory distress on the setting of community-acquired pneumonia, diastolic heart failure, ischemic heart disease, pulmonary hypertension, chronic kidney disease, and hypertension. The patient presented with orthopnea, fever, bilateral pleuritic chest pain, and productive cough with yellowish sputum for 7 days. She had no previous chest trauma or surgical intervention. TTE demonstrated the tortuous enlargement of left coronary artery which drains into the pulmonary arterial trunk right above the pulmonary valve. As the patient was in advanced age with multiple comorbidities; we offered a conservative management including diuretic, oxygen therapy, antibiotic, antiplatelet, and statin. She recovered following a 13-day hospitalization. To our knowledge, this is the oldest case report of suspected congenital CPAF which is particularly detected by TTE.
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Affiliation(s)
- Thai Truong
- Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | | | | | | | | | - Tu Anh Phan
- Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Hannah Hue Phan
- University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Phillip Tran
- Nam Can Tho University, School of Medicine, Can Tho, Vietnam
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25
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Wallner M, Eaton DM. Straight Through the Heart: A Rare Cause of Coronary Artery Fistulae. JACC Case Rep 2021; 3:39-40. [PMID: 34317465 PMCID: PMC8305622 DOI: 10.1016/j.jaccas.2020.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Markus Wallner
- Department of Cardiology, Medical University of Graz, Graz, Austria
- Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
- Center for Biomarker Research in Medicine, CBmed GmbH, Graz, Austria
| | - Deborah M. Eaton
- Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
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26
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Large symptomatic coronary artery fistulas draining to the left heart: transcatheter management. Cardiol Young 2021; 31:148-150. [PMID: 33059778 DOI: 10.1017/s1047951120003364] [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: 11/06/2022]
Abstract
Large coronary artery fistulas draining to the left heart structures causing heart failure are very rare. Interventional closure of such fistulas is limited to isolated reports, often in asymptomatic patients. Technical differences in these interventions include either deep arterial cannulation till their exit or transseptal arteriovenous circuit formation. Transcatheter closure of three large symptomatic fistulas in small children is reported.
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27
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Patel NR, Prabhakar Bhat S, Solanki S, Bauch T, Nawaz Y. Coronary Steal in a Patient With Apical Hypertrophic Cardiomyopathy: A Rare Case of Symptomatic Coronary Artery Fistula. Cureus 2020; 12:e11793. [PMID: 33409039 PMCID: PMC7779155 DOI: 10.7759/cureus.11793] [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] [Indexed: 11/27/2022] Open
Abstract
This report describes a rare case of multiple left coronary artery to pulmonary artery/left atrial fistulae causing a coronary steal phenomenon. A 58-year-old male with apical hypertrophic cardiomyopathy was seen in an outpatient office for exertional chest pain and dyspnea and subsequently had a positive exercise nuclear stress test. Coronary angiogram revealed 70-80% mid-left anterior descending artery stenosis with multiple proximal coronary artery to left atrial/pulmonary artery fistulae. Due to symptomatic coronary artery fistulae with coronary steal phenomenon, the patient underwent surgical correction of fistulae with bypass graft to left anterior descending artery. To our knowledge, this is the first case report on co-existing apical hypertrophic cardiomyopathy and coronary artery-left atrial/pulmonary artery fistulae. This article reviews current guidelines for management of coronary artery fistula.
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28
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Nair A, Sheth K, Sheth R, Dalvi B. Transcatheter treatment of an unusual coronary arteriovenous malformation with a fistulous sac in the interventricular septum. Ann Pediatr Cardiol 2020; 14:91-94. [PMID: 33679070 PMCID: PMC7918023 DOI: 10.4103/apc.apc_55_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/29/2020] [Accepted: 09/19/2020] [Indexed: 11/14/2022] Open
Abstract
Coronary artery fistula (CAF) is a rare congenital anomaly with a reported incidence of 0.2%–0.6%. There is a wide variation in the clinical presentation depending on the size and the site of the fistula. Transcatheter closure is currently the treatment of choice in these patients. We report a case of CAF with an unusually large fistulous sac within the interventricular septum. The fistula had connections with all the three major coronary arteries, namely, left anterior descending (LAD), left circumflex, and right coronary arteries but did not have any exit resulting in to and fro movement of blood within the sac and the feeding vessels. The patient was managed successfully by transcatheter coil embolization.
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Affiliation(s)
- Anupama Nair
- Department of Pediatric Cardiology, Sir H N Reliance Hospital, Girgaum, Mumbai, Maharashtra, India
| | - Kshitij Sheth
- Department of Pediatric Cardiology, Sir H N Reliance Hospital, Girgaum, Mumbai, Maharashtra, India
| | - Rahul Sheth
- Department of Radiology, Sir H N Reliance Hospital, Girgaum, Mumbai, Maharashtra, India
| | - Bharat Dalvi
- Department of Pediatric Cardiology, Sir H N Reliance Hospital, Girgaum, Mumbai, Maharashtra, India
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29
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Cui C, Liang W, Fan T, Liu L. Prenatal diagnosis of a right coronary artery to right atrial fistula with a giant coronary artery aneurysm: A case report. JOURNAL OF CLINICAL ULTRASOUND : JCU 2020; 48:489-492. [PMID: 32491209 DOI: 10.1002/jcu.22873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 03/02/2020] [Accepted: 05/08/2020] [Indexed: 06/11/2023]
Abstract
Coronary artery fistula (CAF) is a rare cardiac anomaly. Here, we diagnosed a right coronary artery-right atrium fistula with giant coronary artery aneurysm (CAA) via fetal echocardiography at 35 weeks' gestation. An urgent caesarean delivery was performed at 36 weeks' gestation because CAA caused mitral obstruction, and fetal atrial flutter was present. Following delivery, we performed aneurysm ligation because the new-born developed atrial tachycardia. The intraoperative findings confirmed the sonographic findings. To the best of our knowledge, prenatal ultrasound diagnosis of CAF and giant CAA has not been reported in the literature. We focus on the ultrasonic characteristics and differential diagnosis in this literature.
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Affiliation(s)
- Cunying Cui
- Department of ultrasonography, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Weijie Liang
- Children's Cardiac Center, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Taibing Fan
- Children's Cardiac Center, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Lin Liu
- Department of ultrasonography, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Zhengzhou, Henan, China
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30
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Wu W, Li Y, Fang L, Yang Y, Xie M. Multimodality imaging in preparation for surgery of coronary to pulmonary arterial fistulas complicated with a huge coronary aneurysm. Echocardiography 2019; 36:2126-2128. [PMID: 31621955 DOI: 10.1111/echo.14501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 09/26/2019] [Indexed: 11/28/2022] Open
Abstract
Coronary to pulmonary arterial fistula complicated with huge coronary aneurysm is a very rare condition. In this paper, we report a patient with bilateral coronary arteries to pulmonary artery fistulas with a giant coronary artery aneurysm. The patient was treated successfully by closure of the fistulas and repair of the coronary artery aneurysm with the preparation of multimodality imaging for surgery.
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Affiliation(s)
- Wenqian Wu
- Department of Ultrasound, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Province Laboratory of Molecular Imaging, Wuhan, China
| | - Yuman Li
- Department of Ultrasound, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Province Laboratory of Molecular Imaging, Wuhan, China
| | - Lingyun Fang
- Department of Ultrasound, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Province Laboratory of Molecular Imaging, Wuhan, China
| | - Yali Yang
- Department of Ultrasound, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Province Laboratory of Molecular Imaging, Wuhan, China
| | - Mingxing Xie
- Department of Ultrasound, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Province Laboratory of Molecular Imaging, Wuhan, China
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31
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Alsalehi M, Jeewa A, Wan A, Contreras J, Yoo SJ, Laks JA. A case series of left main coronary artery ostial atresia and a review of the literature. CONGENIT HEART DIS 2019; 14:901-923. [PMID: 31532081 DOI: 10.1111/chd.12842] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 08/29/2019] [Indexed: 11/29/2022]
Abstract
Left main coronary artery ostial atresia (LMCAOA) is a rare congenital anomaly of the coronary arteries. The published literature regarding the current diagnostic and management recommendations are limited. We present three case series of LMCAOA from our institution, including one with a unique association with anomalous origin of left coronary artery (LCA) from pulmonary artery. In addition, this report includes a review of 50 pediatric and 43 adult cases from literature. The majority of the patients were symptomatic. Sudden cardiac death occurred in 10% of pediatric patients and 7% of adult patients. Almost half of pediatric patients had additional cardiac lesions. At the time of diagnosis, 82% of patients had abnormal exercise stress test and 73% had abnormal myocardial perfusion imaging (MPI). The diagnosis of LMCAOA was suspected by echocardiography in 47% of pediatric patients, while 26% were initially misdiagnosed as anomalous origin of LCA from pulmonary artery. Coronary angiography confirmed the diagnosis in most cases and 70.5% of pediatric patients had small collaterals, while 80.5% of adult patients had large collaterals. Nine pediatric patients had no revascularization surgery with five deaths. Revascularization surgery was performed in 39 pediatric patients with four deaths. After 2005, there is a gradual shift toward performing coronary osteoplasty rather than coronary artery bypass grafting. Eighteen adult patients had revascularization surgery and all survived. Fifteen adult patients had no revascularization surgery, of which there were five deaths. In patients with LMCAOA, revascularization surgery is currently recommended in the presence of symptoms, ischemic changes on electrocardiogram or exercise stress test, myocardial perfusion defect on MPI, global left ventricular systolic dysfunction on echocardiogram, severe mitral regurgitation, or small-sized collaterals in coronary angiography. Short-term and mid-term outcomes are encouraging.
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Affiliation(s)
- Mahmoud Alsalehi
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Aamir Jeewa
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Andrea Wan
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Juan Contreras
- Division of Cardiovascular Surgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Shi-Joon Yoo
- Division of Cardiac Imaging, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Jessica A Laks
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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32
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Abo-Salem E, Decanio R, Leesar M, Abruzzo T, Vu D, Alkhawam H, Ristagno R. Percutaneous closure of right coronary to superior vena cava fistula. Future Cardiol 2019; 15:161-167. [PMID: 31148466 DOI: 10.2217/fca-2018-0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Coronary artery to superior vena cava (SVC) fistula is a very rare congenital anomaly of the heart. It typically follows the course of sinoatrial-nodal branch. It can originate from the right coronary or circumflex artery. In the majority of cases, it terminates in the SVC close to the right atrium junction. Only five cases were treated in literature successfully through a transcatheter approach. We present a case with a symptomatic right coronary artery to SVC fistula treated with a unique percutaneous embolization using a guidewire loop/balloon occlusion technique. Controlled access and embolization of the fistula was achieved by through-and-through guidewire access across the coronary fistula from the arterial groin access to the venous groin access with balloon occlusion of the coronary artery fistula while detachable coils were positioned.
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Affiliation(s)
- Elsayed Abo-Salem
- Center for Comprehensive Cardiovascular Care, Saint Louis University Hospital, St. Louis, MO 63110, USA
| | - Raymond Decanio
- Division of Radiology, University of Cincinnati, Cincinnati, OH 45221, USA
| | - Massoud Leesar
- Department of Cardiology, The University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Todd Abruzzo
- Division of Radiology, University of Cincinnati, Cincinnati, OH 45221, USA
| | - Doan Vu
- Division of Radiology, University of Cincinnati, Cincinnati, OH 45221, USA
| | - Hassan Alkhawam
- Center for Comprehensive Cardiovascular Care, Saint Louis University Hospital, St. Louis, MO 63110, USA
| | - Ross Ristagno
- Division of Radiology, University of Cincinnati, Cincinnati, OH 45221, USA
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33
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Acute coronary syndrome and coronary microfistulae left ventricular. COR ET VASA 2019. [DOI: 10.1016/j.crvasa.2018.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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De Roeck F, Franssen C, De Wolf D, Haine S. Exercise-induced ventricular arrhythmia due to bilateral coronary to pulmonary artery fistulas. Catheter Cardiovasc Interv 2019; 94:112-116. [DOI: 10.1002/ccd.28108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/26/2018] [Accepted: 01/02/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Frederic De Roeck
- Department of Cardiology; Antwerp University Hospital; Edegem Belgium
| | | | - Daniel De Wolf
- Department of Cardiology; Antwerp University Hospital; Edegem Belgium
- Department of Pediatric Cardiology; Ghent University Hospital; Ghent Belgium
| | - Steven Haine
- Department of Cardiology; Antwerp University Hospital; Edegem Belgium
- Cardiology, Department of Translational Pathophysiological Research; University of Antwerp; Wilrijk Belgium
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35
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Haller C. Commentary: The challenging management of coronary artery fistulas. J Thorac Cardiovasc Surg 2019; 157:e205-e206. [PMID: 30638618 DOI: 10.1016/j.jtcvs.2018.11.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 11/29/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Christoph Haller
- Department of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
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36
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Uchida T, Hamasaki A, Kuroda Y, Yamashita A, Sadahiro M. Surgical management of proximal coronary arteriovenous fistulas using intraoperative fluorescence imaging. J Card Surg 2018; 33:836-839. [DOI: 10.1111/jocs.13942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Tetsuro Uchida
- Second Department of SurgeryFaculty of MedicineYamagata UniversityYamagataJapan
| | - Azumi Hamasaki
- Second Department of SurgeryFaculty of MedicineYamagata UniversityYamagataJapan
| | - Yoshinori Kuroda
- Second Department of SurgeryFaculty of MedicineYamagata UniversityYamagataJapan
| | - Atsushi Yamashita
- Second Department of SurgeryFaculty of MedicineYamagata UniversityYamagataJapan
| | - Mitsuaki Sadahiro
- Second Department of SurgeryFaculty of MedicineYamagata UniversityYamagataJapan
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37
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Sakai M, Mori K, Hoshiai S, Kikuchi S, Hoshi T, Sato A, Ohtani M, Minami M. Successful transarterial embolization of coronary artery fistula with ruptured aneurysm: A case report. Radiol Case Rep 2018; 14:126-128. [PMID: 30386452 PMCID: PMC6205050 DOI: 10.1016/j.radcr.2018.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 10/14/2018] [Indexed: 01/27/2023] Open
Abstract
We report a case of a coronary artery fistula (CAF) with ruptured aneurysm treated using transarterial embolization (TAE) alone. The ruptured aneurysm caused cardiac tamponade, and it was isolated by embolizing its afferent and efferent vessels using detachable coils. To our knowledge, this is the first case report of successful TAE for a CAF with ruptured aneurysm. We believe that if the patient condition is stable and the CAF is anatomically simple, TAE can be a less-invasive alternative to surgery.
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Affiliation(s)
- Masafumi Sakai
- Department of Diagnostic & Interventional Radiology, University of Tsukuba Hospital, Amakubo 2-1-1, Tsukuba, Ibaraki 305-8576, Japan
| | - Kensaku Mori
- Department of Radiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Sodai Hoshiai
- Department of Radiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Shunsuke Kikuchi
- Department of Diagnostic & Interventional Radiology, University of Tsukuba Hospital, Amakubo 2-1-1, Tsukuba, Ibaraki 305-8576, Japan
| | - Tomoya Hoshi
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Akira Sato
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Masafumi Ohtani
- Department of Cardiology, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Manabu Minami
- Department of Radiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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38
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Tian M, Wang X, Gao H, Wang L, Hu S. Left main coronary artery atresia with concomitant mitral regurgitation in an adult: A case report. Medicine (Baltimore) 2018; 97:e12367. [PMID: 30313032 PMCID: PMC6203469 DOI: 10.1097/md.0000000000012367] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Left main coronary artery (LMCA) atresia is a quite rare congenital malformation, which may present with various symptoms. Past literatures were sporadic without recent summary of world-wide cases. We hereby report an adult case of LMCA atresia with concomitant mitral regurgitation and also summarize all cases found in published literatures. CASE PRESENTATION A 48-year old female presented with sudden dyspnea. Preliminary impression was acute heart failure caused by mitral regurgitation. Preoperative coronary angiography demonstrated that there was no left coronary ostium and multiple collateral vessels arising from right coronary artery. The diagnosis of left main coronary atresia was made and the patient received successful valvuloplasty and coronary artery bypass grafting with left internal mammary artery anastomosed to the left anterior descending (LAD) artery. She recovered well and 3-month follow-up showed the graft was patent. CONCLUSION This case highlights the importance of angiography for diagnosis of LMCA and performance of CABG once diagnosed.
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Rizvi SSA, Choi JH, Tchantchaleishvili V, Massey HT. Large left main coronary artery aneurysm with fistula to the right atrium. J Thorac Dis 2018; 10:E456-E458. [PMID: 30069404 DOI: 10.21037/jtd.2018.05.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Syed Saif Abbas Rizvi
- Division of Cardiothoracic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Jae Hwan Choi
- Division of Cardiothoracic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | | | - Howard Todd Massey
- Division of Cardiothoracic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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40
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Asvestas D, Bazoukis G, Tse G, Lampropoulos K, Salachas A. Bilateral coronary arteriovenous fistulas drained into the left ventricle. Hellenic J Cardiol 2018; 59:244-246. [PMID: 29305901 DOI: 10.1016/j.hjc.2017.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 11/25/2017] [Accepted: 12/04/2017] [Indexed: 11/25/2022] Open
Affiliation(s)
- Dimitrios Asvestas
- Department of Cardiology, Catheterization Laboratory, Evangelismos General Hospital of Athens, Greece
| | - George Bazoukis
- Department of Cardiology, Catheterization Laboratory, Evangelismos General Hospital of Athens, Greece.
| | - Gary Tse
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China; Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China.
| | - Konstantinos Lampropoulos
- Department of Cardiology, Catheterization Laboratory, Evangelismos General Hospital of Athens, Greece
| | - Anastasios Salachas
- Department of Cardiology, Catheterization Laboratory, Evangelismos General Hospital of Athens, Greece
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41
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Kim CY, Choi JY, Kim KS. A coronary artery fistula having connection between 2 coronary arteries and the left ventricle: A case report. Medicine (Baltimore) 2017; 96:e8546. [PMID: 29137066 PMCID: PMC5690759 DOI: 10.1097/md.0000000000008546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Cases of coronary artery fistula having a connection with the cardiac cavity are rare. Here, we report a case in which 2 coronary arteries empty into the left ventricular cavity together. PATIENT CONCERNS A 63-year-old woman who was diagnosed as having hypertension 20 years prior presented with dyspnea. DIAGNOSES The coronary angiography revealed coronary artery fistula. INTERVENTIONS Chest X-ray showed pulmonary edema. Transthoracic echocardiography revealed moderately decreased left ventricular (LV) function and increased LV end-diastolic volume and mass index. Coronary angiography and cardiac computed tomography revealed that 2 coronary arteries joined together at the distal end and directly drained into the left ventricular cavity bypassing the myocardial capillary vessels. We started medical treatment for heart failure with an angiotensin-converting-enzyme inhibitor, loop diuretic, and spironolactone. OUTCOMES The pulmonary edema improved rapidly. The patient did not experience dyspnea after discharge, and follow-up echocardiography showed improved cardiac function. MAIN LESSON Coronary artery fistula could be found incidentally on coronary angiography performed for varied reasons. Physicians must decide carefully whether the fistula needs to be treated in view of the clinical context.
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42
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Koutaka M, Hyougo H, Tsugo K, Une Y. Anomalous origin of the right coronary artery from the pulmonary artery and congenital bicuspid aortic valve in a California sea lion (Zalophus californianus). J Vet Med Sci 2017; 79:1559-1562. [PMID: 28781293 PMCID: PMC5627328 DOI: 10.1292/jvms.16-0522] [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] [Indexed: 11/22/2022] Open
Abstract
A 27-year-old captive female California sea lion (Zalophus californianus) died suddenly. Necropsy findings showed severe hemopericardium, the right coronary artery arose from the sinus of the pulmonary trunk, and the aortic valve was composed of two semilunar cusps. Coronary artery branches emerging from the epicardium were dilated and tortuous. Pampiniform vascular plexus formation existed along the adventitia from the coronal sulcus to the pulmonary trunk. This is the first report of multiple congenital cardiac malformations with an anomalous origin of the right coronary artery from the pulmonary artery and a bicuspid aortic valve in a marine mammal.
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Affiliation(s)
- Mitsuru Koutaka
- Marine World Umino-nakamichi, 18-28 Saitozaki, Higashi-ku, Fukuoka-shi, Fukuoka 811-0321, Japan
| | - Hanami Hyougo
- Laboratory of Veterinary Pathology, Azabu University, 1-17-71 Fuchinobe, Chuo-ku, Sagamihara, Kanagawa 252-5201, Japan
| | - Kousuke Tsugo
- Laboratory of Veterinary Pathology, Azabu University, 1-17-71 Fuchinobe, Chuo-ku, Sagamihara, Kanagawa 252-5201, Japan
| | - Yumi Une
- Laboratory of Veterinary Pathology, Azabu University, 1-17-71 Fuchinobe, Chuo-ku, Sagamihara, Kanagawa 252-5201, Japan
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Dual origin multiple plexus-like coronary to pulmonary artery fistulas – Consideration of their etiology and therapeutic strategy. J Cardiol 2017; 69:747-751. [DOI: 10.1016/j.jjcc.2016.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 06/29/2016] [Accepted: 07/19/2016] [Indexed: 11/20/2022]
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Kumar YK, Mehta SB, Ramachandra M. Numerical modeling of vessel geometry to measure hemodynamics parameters non-invasively in cerebral arteriovenous malformation. Biomed Mater Eng 2017; 27:613-631. [PMID: 28234245 DOI: 10.3233/bme-161613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cerebral arteriovenous malformations (CAVM) are congenital lesions that contain a cluster of multiple arteriovenous shunts (NIDUS). Cardiac arrhythmia in CAVM patients causes irregular changes in blood flow and pressure in the NIDUS area. This paper proposes the framework for creating the lumped model of tortuous vessel structure near NIDUS based on radiological images. This lumped model is to analyze flow variations, with various combinations of the transient electrical signals, which simulate similar conditions of cardiac arrhythmia in CAVM patients. This results in flow variation at different nodes of the lumped model. Here we present two AVM patients with evaluation of 150 vessels locations as node points, with an accuracy of 93%, the sensitivity of 95%, and specificity of 94%. The calculated p-value is smaller than the significance level of 0.05.
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Affiliation(s)
- Y Kiran Kumar
- Philips Research, Research scholar, Manipal University, India
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Shi K, Gao HL, Yang ZG, Zhang Q, Liu X, Guo YK. Preoperative evaluation of coronary artery fistula using dual-source computed tomography. Int J Cardiol 2017; 228:80-85. [PMID: 27863365 DOI: 10.1016/j.ijcard.2016.11.169] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 11/06/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To evaluate the efficacy of dual-source computed tomography (DSCT) in assessing the morphological features, quantitative features, and associated coronary artery lesions among patients with coronary artery fistula (CAF) before surgery. METHODS We enrolled 34 patients with CAF that were morphologically and quantitatively analyzed by DSCT and compared the analyses with surgical results (reference standard). The associated coronary artery lesions were also assessed. RESULTS By DSCT, we identified 15 patients (44.1%) with left-sided CAF, 9 (26.5%) with right-sided CAF, and 10 (29.4%) with bilateral CAF; the left anterior descending coronary artery (50.0%) was most frequently involved. Drainage was most commonly in the main pulmonary artery (41.2%), and those with right-sided CAF had larger feeding coronary arteries and drainage sites than those with left-sided or bilateral CAF (p<0.05). All the morphological features presented by DSCT were confirmed at surgery. In the quantitative analysis of CAF, DSCT was as accurate as surgery (r=0.95-0.98, p<0.001), and it was able to evaluate associated lesions accurately, including arteriosclerotic plaques, coronary artery aneurysms, and myocardial bridges. The evaluation could be completed in a single scan, without requiring an increased radiation dose (mean ED=2.27±1.92mSv). CONCLUSIONS DSCT is an alternative noninvasive imaging method that enables accurate assessment of morphological features, quantitative features, and associated coronary artery lesions in patients with CAF. It can be used to provide comprehensive information for determining surgical strategies.
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Affiliation(s)
- Ke Shi
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan 610041, China
| | - Hong-Ling Gao
- Department of Cardiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan 610041, China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan 610041, China.
| | - Qin Zhang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan 610041, China
| | - Xi Liu
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan 610041, China
| | - Ying-Kun Guo
- Department of Radiology, West China Second University Hospital, Sichuan University, 20# Section 3 South Renmin Road, Chengdu, Sichuan 610041, China.
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Lalude OO, Lerakis S. Cardiovascular Magnetic Resonance Imaging. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
| | - Stamatios Lerakis
- Emory University School of Medicine and Georgia Institute of Technology; Atlanta GA USA
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Role of 256-slice MDCT in the evaluation of coronary artery fistula: A case series with review of literature. Med J Armed Forces India 2016; 72:393-399. [PMID: 27843191 DOI: 10.1016/j.mjafi.2016.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 06/13/2016] [Indexed: 11/21/2022] Open
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Rodriguez JD. Incidental Finding of a Right Coronary Artery to Coronary Sinus Fistula in an Adult Transthoracic Echocardiogram. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2016. [DOI: 10.1177/8756479316664339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Congenital coronary artery fistula (CAF) is a rare anomaly of the heart presenting in 0.002% of the general population. This case study presents an adult patient with an undiagnosed heart murmur and symptoms of chest pain, fatigue, and lightheadedness that demonstrated an incidental finding of CAF diagnosed by transthoracic echocardiography. Transthoracic echocardiography revealed an aneurysmal, tortuous right coronary artery terminating in a dilated coronary sinus. Sonographic findings were compared with angiography and computed tomography. This study highlights the potential of transthoracic echocardiography to assess heart structure and physiology and detect a CAF.
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Kanda Y, Takahashi T, Yokoyama I, Momomura SI, Serizawa T. Coronary Artery-Coronary Sinus Fistulae Associated with a Large Hepatic Hemangioma. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/153857449502900110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
A case of coronary artery-coronary sinus fistulae associated with a large hepatic hemangioma is presented. Aortography and coronary arteriography revealed a large left circumflex artery-coronary sinus fistula and a small right coronary artery-coronary sinus fistula. The left main trunk and left circumflex artery were markedly enlarged (3 cm in diameter), while the sizes of the left anterior descending and right coronary arteries were normal. Abdominal angiography and noninvasive imaging techniques demonstrated a huge hepatic hemangioma (8 cm in diameter) in the S5 region of the liver.
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Affiliation(s)
| | | | | | | | - Takashi Serizawa
- Second Department of Internal Medicine, Faculty of Medicine, University of Tokyo, Tokyo, Japan
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