An unusual case of coronary artery fistula to the pulmonary artery, diagnosed with 64-MDCT coronary angiography

AbstractCoronary artery fistulae are an incidental finding in patients undergoing coronary angiography or computed tomography (CT) coronary angiography. A 60-year-old man with known coronary artery disease presented with dyspnea. Coronary angiography revealed a large fistula arising from the circumflex artery (CX) without a clear intrathoracic target vessel or chamber in the heart. CT angiography revealed the agenesis of the left pulmonary artery. The fistula arising from the CX ensured left lung tissue supply. Unilateral absence of a pulmonary artery is an extremely rare condition. In this case, the identification of a fistula from the heart triggered the correct diagnosis.

Download Full-text

Multi-Modality Imaging of Coronary Artery Fistula with Giant Aneurysms

The Heart Surgery Forum ◽

10.1532/hsf.1770 ◽

2017 ◽

Vol 20 (5) ◽

pp. 191

Author(s):

Hae Won Jung ◽

Sung Yun Lee ◽

Yoon Cheol Shin ◽

Woo-Ik Chang ◽

Jun Hyun Kim ◽

...

Keyword(s):

Chest Pain ◽

Coronary Artery ◽

Coronary Angiography ◽

Pulmonary Artery ◽

Surgical Repair ◽

Coronary Artery Fistula ◽

Chief Complaint ◽

Giant Aneurysms ◽

Left Anterior Descending Artery ◽

Standard Tool

A 50-year-old woman was referred to our hospital with a chief complaint of chest pain. Coronary angiography revealed a fistula between the left anterior descending artery and pulmonary artery with giant aneurysms. Although coronary angiography is considered the standard tool to confirm a coronary artery fistula, the patient in this case underwent successful surgical repair with the aid of multi-modality imaging.

Download Full-text

Ligation of a Fistula between the Left Main Coronary Artery and Both the Pulmonary Artery and the Right Ventricle

The Heart Surgery Forum ◽

10.1532/hsf98.20111083 ◽

2012 ◽

Vol 15 (2) ◽

pp. 119 ◽

Cited By ~ 2

Author(s):

I. Halil Algin ◽

Aytekin Yesilay ◽

N. Murat Akcar

Keyword(s):

Cardiopulmonary Bypass ◽

Coronary Artery ◽

Pulmonary Artery ◽

Right Ventricle ◽

Left Main Coronary Artery ◽

Coronary Artery Fistula ◽

Left Main ◽

Symptomatic Disease ◽

Coronary Artery Fistulas ◽

The Right

The frequency of coronary artery fistula among all coronary angiography patients is 0.1% to 0.2%; however, involvement of both the pulmonary artery and the right ventricle is a rare clinical entity. A 53-year-old man patient was admitted to our clinic with rarely occurring chest pain, palpitations, and dyspnea. A coronary angiogram showed a fistula between the left main coronary artery and both the pulmonary artery and the right ventricle. We performed a ligation of this fistula without cardiopulmonary bypass. Aorta and right ventricle sutures were made, and the proximal and distal portions of the fistula were obliterated with 5-0 Prolene sutures and previously prepared Teflon felt. The patient recovered and was discharged without any complications. The surgical indications for coronary artery fistulas are symptomatic disease, an aneurysmic coronary artery, signs of heart failure, and ischemia. The surgical options in such cases�depending on whether the fistula is complicated or not�are simple ligation or transarterial ligation under cardiopulmonary bypass.

Download Full-text

Coronary artery fistula between the left anterior descending artery and pulmonary artery

Baylor University Medical Center Proceedings ◽

10.1080/08998280.2017.1401380 ◽

2018 ◽

Vol 31 (1) ◽

pp. 64-66 ◽

Cited By ~ 1

Author(s):

Abdul Al-Douri ◽

Ari Cedars ◽

Dat Tran

Keyword(s):

Coronary Artery ◽

Pulmonary Artery ◽

Coronary Artery Fistula ◽

Left Anterior Descending Artery

Download Full-text

COILUMICA: coil embolization of a coronary artery to pulmonary artery fistula via novel dual lumen micro catheter technique

CVIR Endovascular ◽

10.1186/s42155-020-00177-4 ◽

2020 ◽

Vol 3 (1) ◽

Author(s):

Mithun Nambiar ◽

Julian Maingard ◽

Kenny Li ◽

Lee-Anne Slater ◽

Ronil V. Chandra ◽

...

Keyword(s):

Coronary Artery ◽

Pulmonary Artery ◽

Coil Embolization ◽

Coronary Artery Fistula ◽

Exertional Dyspnea ◽

Balloon Catheters ◽

Catheter Technique ◽

Patient Reported ◽

Pulmonary Artery Fistula ◽

Micro Catheter

Abstract Background Management of coronary artery fistula (CAF) is based on obliterating the fistula communication between the cardiac arteries and other thoracic vessels. Case presentation We describe the presentation of an 85-year-old female with progressive exertional dyspnea on a background of a long standing left anterior descending diagonal to pulmonary artery fistula. We utilized neuro-interventional techniques to perform coil embolization via use of a Scepter XC dual lumen micro catheter. Conclusions Dual lumen balloon catheters allow for super-selective artery interrogation, stability of balloon positioning, with less trauma to vessel architecture and accurate embolization. There were no complications and the patient reported improvement of symptoms on review.

Download Full-text

A complex coronary artery fistula with aberrant mediastinic and abdominal feeding arteries and pulmonary artery drainage

Journal of Cardiovascular Medicine ◽

10.2459/jcm.0b013e32834a397c ◽

2011 ◽

Vol 12 (9) ◽

pp. 653-654 ◽

Cited By ~ 3

Author(s):

Vincenzo Russo ◽

Giangaspare Mineo ◽

Giovanni Rinaldi ◽

Maurizio Zompatori ◽

Rossella Fattori

Keyword(s):

Coronary Artery ◽

Pulmonary Artery ◽

Coronary Artery Fistula

Download Full-text

Abstract 2594: Coronary Multidetector Computed Tomography in the Prognostic Assessment of Patients with Equivocal or Mildly Abnormal Non-Invasive Cardiac Stress Tests

Circulation ◽

10.1161/circ.116.suppl_16.ii_574-c ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Clerio Azevedo ◽

Mariane Spotti ◽

Sabrina Bezerra ◽

Marcelo Hadlich ◽

Humberto Villacorta ◽

...

Keyword(s):

Computed Tomography ◽

Coronary Artery ◽

Coronary Angiography ◽

Confidence Interval ◽

Coronary Stenosis ◽

Atherosclerotic Plaques ◽

Stress Tests ◽

Cardiac Stress ◽

Non Invasive ◽

Mdct Coronary Angiography

Background: Patients with low or moderate pre-test probability of significant coronary artery disease (CAD) and equivocal or mildly abnormal non-invasive cardiac stress tests represent a frequent management challenge. Coronary multidetector computed tomography (MDCT) has been shown to have excellent diagnostic accuracy to exclude the presence of significant CAD. Methods: The study included 218 patients (mean age 59±12 years, 60% male) with equivocal or mildly abnormal exercise electrocardiography (n=93), stress SPECT perfusion scans (n=121), stress echocardiography (n=3) and stress cardiac MRI (n=1). Patients were either asymptomatic (n=113) or had atypical chest pain (n=105). All patients underwent contrast-enhanced 64-slice MDCT coronary angiography and datasets were evaluated for the presence of coronary atherosclerotic plaques and significant coronary artery stenosis. Patients were followed for 8±3 months and the endpoints evaluated were: cardiac death, myocardial infarction, revascularization procedure performed >3 months after MDCT coronary angiography and unstable angina requiring hospitalization. Results: MDCT coronary angiography was either normal (n=90; 41%), demonstrated non-obstructive coronary atherosclerotic plaques (n=66; 30%) or exhibited significant coronary stenosis (n=62; 29%). Event-free survival was 100% for patients with normal coronary angiography, 98% for patients with non-obstructive plaques and 92% for patients with coronary stenosis (log-rank test P=0.01). One patient with a non-obstructive plaque involving the left main coronary artery died following an AMI (hazard ratio, 0.38; 95% confidence interval, 0.04 to 3.24). Among patients with coronary stenosis, 3 underwent revascularization procedures and 2 died (hazard ratio, 12.59; 95% confidence interval, 1.47 to 107.86). Conclusion: Among patients with equivocal or mildly abnormal non-invasive cardiac stress tests, a normal MDCT coronary angiography is associated with a very low risk for subsequent cardiac events. Further studies are necessary to determine the clinical significance of non-obstructive atherosclerotic plaques detected by MDCT coronary angiography in this patient population.

Download Full-text