Prenatal diagnosis of isolated coronary artery fistulas: progression and outcome in five cases

2015 ◽  
Vol 26 (5) ◽  
pp. 915-920 ◽  
Author(s):  
Gurleen K. Sharland ◽  
Laura Konta ◽  
Shakeel A. Qureshi
Keyword(s):  
Coronary Artery ◽  
Cardiac Failure ◽  
Transcatheter Closure ◽  
Coronary Artery Fistula ◽  
Congestive Cardiac Failure ◽  
Fetal Life ◽  
Circumflex Coronary Artery ◽  
Coronary Artery Fistulas ◽  
The Right

AbstractObjectivesThe aim of this study was to describe the clinical characteristics, progression, treatment, and outcomes in isolated coronary artery fistula cases diagnosed prenatally.MethodsWe carried out a retrospective review of babies diagnosed prenatally with coronary artery fistulas between January, 2000 and December, 2013; five fetuses were included. Echocardiographic features and measurements were noted during pregnancy and after birth. Treatment and outcome were noted.ResultsGestational age at initial diagnosis was between 19 and 22 weeks; four coronary artery fistulas originated from the right and one from the left circumflex coronary artery. Drainage was into the right atrium in four cases and into the left ventricle in one case. There was cardiomegaly in two cases at the initial scan. The size of the fistulas increased during pregnancy in all except one. All prenatal diagnoses were confirmed postnatally. Among all, two patients developed congestive cardiac failure soon after birth and required transcatheter closure of the coronary artery fistula, 5 and 17 days after birth, respectively; three patients remained asymptomatic, and all of them showed progressive dilation of the feeding artery and had closure of the fistula at 20 months, 4 years, and 7 years of age, respectively. During the follow-up period, which ranged 2–14 years, all the patients were alive and well.ConclusionsCoronary artery fistulas can be diagnosed accurately during fetal life. Some babies may develop congestive cardiac failure soon after birth requiring early treatment. Those treated conservatively should be kept under review as intervention may be required later.

scholarly journals A Case of Coronary Cameral Fistula: When and How to Intervene?

2021 ◽  
Author(s):  
Mehdi Peighambari ◽  
Marziyeh Pakbaz ◽  
Azin Alizadehasl ◽  
Saeid Hosseini ◽  
Hamidreza Pouraliakbar
Keyword(s):  
Coronary Artery ◽  
Unusual Case ◽  
Coronary Artery Fistula ◽  
Circumflex Coronary Artery ◽  
Aged Woman ◽  
Complex Anatomy ◽  
Coronary Artery Fistulas ◽  
Middle Aged Woman ◽  
The Right

Coronary artery fistulas constitute a rare anomaly defined as an abnormal communication between a coronary artery and a great vessel or any cardiac chamber. The majority of these fistulas arise from the right coronary artery and the left anterior descending coronary artery; the circumflex coronary artery is rarely involved. We present an unusual case of a coronary artery fistula in a middle-aged woman who presented with symptoms of heart failure and abnormal auscultation. Echocardiography and conventional and computed tomography angiography showed that the coronary fistula originated from the left circumflex coronary artery and drained majorly into the right ventricle. Given the complex anatomy of the fistula, we managed it surgically rather than percutaneously. There were no complications early after surgery and at 1 year’s follow-up.

Clinical and angiographic follow-up of coronary artery fistula interventions in children: techniques and classification revisited

2014 ◽  
Vol 25 (4) ◽  
pp. 670-680 ◽  
Author(s):  
Bhavesh Thakkar ◽  
Nehal Patel ◽  
Vishal Poptani ◽  
Tarun Madan ◽  
Tarandip Saluja ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Transcatheter Closure ◽  
Coronary Artery Fistula ◽  
Artery Occlusion ◽  
Parent Artery ◽  
Surgical Closure ◽  
Parent Artery Occlusion ◽  
Angiographic Data ◽  
The Right

AbstractBackground: Transcatheter closure of coronary artery fistula has emerged as a safe and effective alternative to surgery. However, follow-up angiographic data after closure of the coronary artery fistula is extremely limited. We report our clinical and angiographic follow-up of children who underwent either transcatheter or surgical closure. Method: Clinical profile, echocardiography parameters, and closure technique were retrospectively reviewed from the hospital charts. Since 2007, 15 children have been intervened and followed up with electrocardiography, echocardiography, and angiography. Results: A total of 15 children (six girls), with mean age of 6.7±5.4 years and weighing 16.3±9.8 kg, underwent successful closure (transcatheter=13, surgical=2) without periprocedural complication. Coronary artery fistula arose from the right (n=7) and left coronary artery (n=8) and drained into the right atrium or the right ventricle. Transcatheter closure was carried out using a duct occluder. Of the patients, two underwent surgical closure of the fistula on a beating heart. At 31.8±18.7 months follow-up, all the children were asymptomatic and had no evidence of myocardial ischaemia or infarction. However, follow-up angiography revealed thrombotic occlusion of fistula with the patent parent coronary artery in those having branch coronary artery fistula, and five of seven patients with parent coronary artery fistula had near-complete occlusion of fistula extending into the native coronary artery. Conclusion: Follow-up angiography revealed a high incidence of parent artery occlusion when the fistula was arising from the native artery and not from one of its branches. Coronary artery fistula intervention of the parent coronary artery fistula always carries the potential risk of ischaemia, unless the distal-most exiting segment is the primary site of occlusion.

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

2012 ◽  
Vol 15 (2) ◽  
pp. 119 ◽  
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.

scholarly journals Successful percutaneous occlusion of a large left circumflex coronary artery fistula draining into the coronary sinus using a ventricular septal defect occluder: a case report

2020 ◽  
Vol 4 (2) ◽  
pp. 1-6
Author(s):  
Anastasia D Egorova ◽  
Peter Ewert ◽  
Martin Hadamitzky ◽  
Andreas Eicken
Keyword(s):  
Coronary Artery ◽  
Ventricular Septal Defect ◽  
Coronary Sinus ◽  
Septal Defect ◽  
Heart Defects ◽  
Coronary Artery Fistula ◽  
Circumflex Coronary Artery ◽  
Left Circumflex Coronary Artery ◽  
Complex Anatomy

Abstract Background Coronary artery fistula (CAF) is a congenital anomaly of the coronaries that can lead to significant intracardiac shunting and myocardial ischaemia. Case summary We describe the case of a 15-year-old male with an incidentally documented precordial cardiac murmur. An evidently dilated coronary sinus (CS) on transthoracic echocardiography prompted further investigation. A computed tomography (CT) revealed the presence of a large CAF from the left circumflex coronary artery to the CS. No other structural heart defects were detected. A haemodynamically significant intracardiac shunt was confirmed during cardiac catheterization, and it was decided to close the fistula. This was successfully performed using a ventricular septal defect (VSD) occluder (Konar 10-8, Lifetech Scientific) that was deployed through a 6 Fr right coronary guiding catheter. A partial thrombotic occlusion of the CS behind the closure device was noted during follow-up which led to anticoagulation in a higher target INR range and concomitant start of low dose carbasalate calcium to reduce further retrograde thrombus extension. Patient is doing well at over 1 year of follow-up, and no further thrombotic extension into the CS was seen on a recent CT. Discussion This report illustrates the diagnostic workup and a percutaneous treatment strategy of a CAF using a VSD occluder. We also describe a not previously reported complication, thrombotic CS occlusion. Improving transcatheter techniques and marketing of novel devices with a broad spectrum of applications can offer new opportunities for treating CAF and avoiding surgical correction often involving cardiopulmonary bypass, reserving this option for patients with complex anatomy or failed transcatheter closure.

scholarly journals Multiple Small Coronary Artery Fistulas Emptying into the Left Ventricle: A Rare but Challenging Problem

2016 ◽  
Vol 2016 ◽  
pp. 1-3
Author(s):  
Omar Kahaly ◽  
Konstantinos Dean Boudoulas
Keyword(s):  
Coronary Artery ◽  
Left Ventricle ◽  
Coronary Artery Fistula ◽  
Coronary Arteriography ◽  
Great Vessel ◽  
Challenging Problem ◽  
Atypical Chest Pain ◽  
Coronary Artery Fistulas ◽  
Appropriate Therapy ◽  
The Right

A coronary artery fistula (CAF) is an abnormal communication between a coronary artery and a cardiac chamber or a great vessel. CAFs are rare based on coronary arteriography and when found they most often empty into the right ventricle and atrium and less often into the high pressure, low compliance left ventricle (LV). A patient who presented with atypical chest pain and was found to have multiple small CAFs originating from the ramus intermedius coronary artery and emptying into the LV is presented. This case highlights the challenges in providing an appropriate therapy for multiple small CAFs emptying into the LV.

scholarly journals Transcatheter Coil Embolization in 17 Patients with 22 Coronary Artery Fistulas

2020 ◽  
Vol 47 (2) ◽  
pp. 135-139
Author(s):  
Ismail Ates ◽  
Zeynettin Kaya ◽  
Deniz Mutlu ◽  
Zehra I. Akyildiz ◽  
Necmettin Korucuk ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Coil Embolization ◽  
Left Coronary Artery ◽  
Success Rates ◽  
Coronary Artery Fistulas ◽  
Transcatheter Coil Embolization ◽  
The Right ◽  
Better Than

Coronary artery fistulas are rare anomalies that often become symptomatic with age. They are typically diagnosed incidentally during coronary angiography. The chief nonsurgical treatment is transcatheter coil embolization. We evaluated the outcomes of this procedure in 17 symptomatic patients who had 22 fistulas in total. The 9 men and 8 women (mean age, 52 ± 16.5 yr; range, 27–74 yr) presented at 4 Turkish hospitals from October 2008 through March 2015. Three patients had multiple fistulas. Twelve fistulas originated from the right coronary artery and 10 from the left coronary artery, draining into the pulmonary artery in 18 instances. We evaluated results postprocedurally and after 2 to 5 months, defining angiographic success as a flow better than Thrombolysis in Myocardial Infarction grade 2 in the treated artery. Twenty-one of the 22 procedures immediately produced the targeted flow. We observed 2 minor and no major complications. On follow-up, 3 symptomatic patients underwent successful repeat treatment of one fistula each. We found that transcatheter coil embolization afforded good success rates with few complications in closing coronary artery fistulas. We share our experience to add to the data on treating patients with coronary artery fistulas, and to raise awareness among clinicians.

scholarly journals Aneurisma del seno de Valsalva con doble rotura a la arteria pulmonar y al ventrículo derecho. Reporte de un caso y revisión de la literatura.

2013 ◽  
Vol 6 (2) ◽  
Author(s):  
Jesús Custodio ◽  
Víctor Arauco ◽  
Milvio Ramirez ◽  
Carlos Cerron
Keyword(s):  
Pulmonary Artery ◽  
Cardiac Catheterization ◽  
Clinical Examination ◽  
Cardiac Failure ◽  
Unusual Presentation ◽  
Congestive Cardiac Failure ◽  
Sinus Of Valsalva ◽  
Right Ventricule ◽  
The Right

We report a case of a 21 year old female who presented with congestive cardiac failure. In initial investigations an aneurysm of sinus of Valsalva was found ruptured to the pulmonary artery. It was surgically repaired uneventfully. The patient was discharged home after 10 days. During the follow-up appointments she was found to have reappearing symptoms of congestive cardiac failure. This lead to her readmission and a repeated cardiac catheterization found her to have an aneurysm of sinus of Valsalva reuptured to the right ventricule, which in a second operation was succesfully repaired. We review the bibliography over the last 20 year finding the unusual presentation of the rupture to the pulmonary artery. We point out the importance of a sharp clinical examination and the preference of cardiac catheterization to make the diagnosis.

scholarly journals Left circumflex coronary artery aneurysm combined with fistula to the left ventricle

2020 ◽  
Author(s):  
Zhang Yue ◽  
Manwei Liu ◽  
Kailun Zhang ◽  
Yali Yang ◽  
Fei Li
Keyword(s):  
Coronary Artery ◽  
Left Ventricle ◽  
Rare Case ◽  
Coronary Artery Aneurysm ◽  
Artery Aneurysm ◽  
Coronary Artery Fistula ◽  
Circumflex Coronary Artery ◽  
Right Heart ◽  
Left Circumflex Coronary Artery ◽  
The Right

Coronary artery fistula (CAF) are abnormal connections between a coronary artery and cardiac chambers or with other vessels. CAF occurs in about 0.1% of adult patients and most commonly affects the right heart. We present a rare case of left circumflex coronary artery aneurysm with fistula to the left ventricle.

Anatomical Classification and Posttreatment Remodeling Characteristics to Guide Management and Follow-Up of Neonates and Infants With Coronary Artery Fistula: A Multicenter Study From the Coronary Artery Fistula Registry

2021 ◽  
Author(s):  
Srinath T. Gowda ◽  
Larry Latson ◽  
Kothandam Sivakumar ◽  
Gurumurthy Hiremath ◽  
Matthew Crystal ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Transcatheter Closure ◽  
Coronary Thrombosis ◽  
Coronary Artery Fistula ◽  
Treatment Method ◽  
Surgical Closure ◽  
Procedural Success ◽  
Partial Thrombosis ◽  
Neonates And Infants

Background: Coronary artery fistulas (CAFs) presenting in infancy are rare, and data regarding postclosure sequelae and follow-up are limited. Methods: A retrospective review of all the neonates and infants (<1 year) was conducted from the CAF registry for CAF treatment. The CAF type (proximal or distal), size, treatment method, and follow-up angiography were reviewed to assess outcomes and coronary remodeling. Results: Forty-eight patients were included from 20 centers. Of these, 30 were proximal and 18 had distal CAF; 39 were large, 7 medium, and 2 had small CAF. The median age and weight was 0.16 years (0.01–1) and 4.2 kg (1.7–10.6). Heart failure was noted in 28 of 48 (58%) patients. Transcatheter closure was performed in 24, surgical closure in 18, and 6 were observed medically. Procedural success was 92% and 94 % for transcatheter closure and surgical closure, respectively. Follow-up data were obtained in 34 of 48 (70%) at a median of 2.9 (0.1–18) years. Angiography to assess remodeling was available in 20 of 48 (41%). I. Optimal remodeling (n=10, 7 proximal and 3 distal CAF). II. Suboptimal remodeling (n=7) included (A) symptomatic coronary thrombosis (n=2, distal CAF), (B) asymptomatic coronary thrombosis (n=3, 1 proximal and 2 distal CAF), and (C) partial thrombosis with residual cul-de-sac (n=1, proximal CAF) and vessel irregularity with stenosis (n=1, distal CAF). Finally, (III) persistent coronary artery dilation (n=4). Antiplatelets and anticoagulation were used in 31 and 7 patients post-closure, respectively. Overall, 7 of 10 (70%) with proximal CAF had optimal remodeling, but 5 of 11 (45%) with distal CAF had suboptimal remodeling. Only 1 of 7 patients with suboptimal remodeling were on anticoagulation. Conclusions: Neonates/infants with hemodynamically significant CAF can be treated by transcatheter or surgical closure with excellent procedural success. Patients with distal CAF are at higher risk for suboptimal remodeling. Postclosure anticoagulation and follow-up coronary anatomic evaluation are warranted.

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