A coronary arterial fistula is a connection between one or more of the coronary arteries and a cardiac chamber or great vessel. This is a rare defect and usually occurs in isolation. Its exact incidence is unknown. The majority of these fistulas are congenital in origin although they may occasionally be detected after cardiac surgery. They do not usually cause symptoms or complications in the first two decades, especially when small. After this age, the frequency of both symptoms and complications increases. Complications include 'steal' from the adjacent myocardium, thrombosis and embolism, cardiac failure, atrial fibrillation, rupture, endocarditis/endarteritis and arrhythmias. Thrombosis within the fistula is rare but may cause acute myocardial infarction, paroxysmal atrial fibrillation and ventricular arrhythmias. Spontaneous rupture of the aneurysmal fistula causing haemopericardium has also been reported. The main differential diagnosis is patent arterial duct, although other congenital arteriovenous shunts need to be excluded. Whilst two-dimensional echocardiography helps to differentiate between the different shunts, coronary angiography is the main diagnostic tool for the delineation of the anatomy. Surgery was the traditional method of treatment but nowadays catheter closure is recommended using a variety of closure devices, such as coils, or other devices. With the catheter technique, the results are excellent with infrequent complications.
#1Sarina K. Behera(UCLA: University of California, Los Angeles)H-Index: 3
#2Saar Danon(UCLA: University of California, Los Angeles)H-Index: 9
Last. John W. Moore(U.H.: University of Hawaii at Manoa)H-Index: 33
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Objective: The aim of this study is to report our experience using the Amplatzer Duct Occluder (ADO) for occlusion of significant coronary artery fistulae (CAF). Background: Transcatheter closure of CAF with coils is well described. Use of newer devices may offer advantages such as improved control of device placement, use of a single instead of multiple devices, and high rates of occlusion. Methods: A retrospective review of all patients catheterized for CAF from July 2002 through August 2005 w...
A 2-year-old girl underwent transcatheter occlusion of a fistula. The fistula originated from the right coronary artery and drained into the right atrium. Three interlocking Gianturco coils were initially placed in the distal portion of the fistula resulting in near-total occlusion of blood flow. Placing a 12-mm Amplatzer vascular plug obliterated the proximal, dilated portion of the fistula. Complete occlusion with accurate placement was achieved. Advantages and technical implications of the Am...
A large fistula from the right coronary artery to the right atrium was diagnosed in a fetus at 22 weeks of gestation. Following delivery, the baby developed cardiac failure. The fistula was occluded at 3 weeks of age by transcatheter implantation of an Amplatzer duct occluder. Large coronary fistulas can be closed safely with a device even at this early age. Vigilance for ischemic events is required following implantation because of the rare possibility of thrombus extension proximally into the ...
In an 11-year old boy with a large coronary arteriovenous fistula between the left coronary artery and the right atrium, we achieved successful closure using a 10–8 Amplatzer Duct Occluder introduced from the right internal jugular vein. Angiography 6 weeks later showed complete occlusion of the fistula, with normal opacification of the left coronary arterial system. This technique may be used as an alternative to coils and surgery in selected patients.
#2Carl L. Backer(NU: Northwestern University)H-Index: 76
Last. Melanie Gevitz(NU: Northwestern University)H-Index: 9
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Background. Coronary artery fistula (CAF) is a rare congenital anomaly that can be complicated by intracardiac shunts, endocarditis, myocardial infarction, or coronary aneurysms. Recent reports have emphasized the efficacy of percutaneous transcatheter techniques. The purpose of this article is to review a 28-year surgical experience with CAF as a standard for comparison and to discuss the emergence and efficacy of transcutaneous catheter coil embolization as an alternative form of therapy. Meth...
The treatment for large congenital coronary cameral fistulas has been surgical but with advances in interventional catheterization techniques transcatheter embolization of these fistulas with coils or detachable balloons is now possible. This report describes occlusion of a congenital coronary arteriovenous fistula in a 6-year-old girl.
Last. Chunguang Chen(UConn: University of Connecticut)H-Index: 1
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Congenital coronary arteriovenous fistula is an unusual, but not rare, coronary anomaly. Management of asymptomatic fistulas is controversial because of great variability in natural history. We describe an 82-year-old female patient with spontaneous rupture of a previously undetected left main coronary artery-to-pulmonary artery coronary arteriovenous fistula, with resulting hemopericardium and cardiac tamponade. Emergent surgical exploration and repair provided successful treatment.
Prenatal diagnosis of a congenital coronary artery fistula between the right coronary artery and right ventricle was made by colour Doppler echocardiography at 20 weeks of gestation. Its progression was monitored by serial echocardiography throughout pregnancy and postnatally.
Last. Michael Tynan(NUS: National University of Singapore)H-Index: 1
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We have demonstrated the value of interlocking detachable coils for catheter occlusion of coronary artery fistulas. This technique should be regarded as the technique of choice.
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 ...
Multimodality imaging provides important information to guide patient selection and pre-procedural decision making for shunt lesions in CHD. While echocardiography, CT, and CMR are well-established, 3D printing and now virtual reality imaging are beginning to show promise.
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 ...
#2Anna S Herrey(St Bartholomew's Hospital)H-Index: 18
Last. Roby Rakhit(UCL: University College London)H-Index: 21
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Background Coronary arterial fistulae are rare yet have been associated with hypertrophic cardiomyopathy (HCM). We present a patient who was found to have a left circumflex (LCx) to left ventricular (LV) fistula in combination with apical HCM. Case summary A 72-year-old female presented with syncope after exercise. She sustained facial injuries including fracture of her nasal bones. There were no previous episodes, no cardiac history, and she denied chest pain or anginal symptoms. Electrocardiog...
Abstract Coronary artery fistulas are rare coronary abnormalities. Most of these fistulas have a congenital origin, and only a few are acquired. We report the case of a patient with late-acquired multiple coronary fistulas secondary to a stab wound, diagnosed in the setting of ischemic heart failure secondary to coronary steal syndrome. (Level of Difficulty: Intermediate.)
#1Mingrui Shao(PRC: China Medical University (PRC))H-Index: 2
#2Tao Han(PRC: China Medical University (PRC))H-Index: 1
Last. Wenya Li(PRC: China Medical University (PRC))H-Index: 6
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Coronary artery fistula (CAF) is a rare condition, whilst lung cancer is one of the most common malignant tumors worldwide. We came cross an interesting case with both diseases. To the best of our knowledge, this is the first case report pertaining to a patient with a coexisting CAF and lung adenocarcinoma. The patient was a 67-year-old woman who was admitted to our hospital for evaluation of persistent cough. Through the examination she was diagnosed coronary artery fistula and lung adenocarcin...
#1Raed Qarajeh(UMKC: University of Missouri–Kansas City)H-Index: 2
#2Aref Qureini(UMKC: University of Missouri–Kansas City)H-Index: 1
Last. Ibrahim M. Saeed(UMKC: University of Missouri–Kansas City)H-Index: 4
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Abstract A 40-year-old African American woman presented with dyspnea, orthopnea, weight gain, and ankle edema. She was admitted for acute decompensated heart failure. Coronary angiography revealed ...
Coronary artery congenital fistulas are rare disorders. Transcatheter closure is the primary method of closure. Device migration is a known complication, for which surgical retrieval is required.
A giant coronary artery aneurysm with arteriovenous fistula is a unique pathology having few surgical reports. An 82-year-old woman presented with a symptomatic giant left circumflex artery aneurysm with a fistula to the coronary sinus. The left coronary artery was dilated, and an aneurysmal change was visible from the left main trunk to the fistula. Surgery was performed to close the fistula and seclude all parts of the aneurysmal coronary artery. All coronary branches emerging from the aneurys...