scholarly journals A case report of a coronary artery fistula to coronary sinus with giant aneurysm: risk does not end with repair

2020 ◽  
Author(s):  
Giulia Poretti ◽  
Mauro Lo Rito ◽  
Alessandro Varrica ◽  
Alessandro Frigiola
Keyword(s):  
Coronary Artery ◽  
Coronary Sinus ◽  
Giant Aneurysm ◽  
Coronary Aneurysm ◽  
Coronary Artery Fistula ◽  
Percutaneous Closure ◽  
Low Flow ◽  
Circumflex Artery ◽  
Coronary Aneurysms

Abstract Background Isolated coronary arteriovenous fistulas are extremely rare, accounting for 0.08–0.4% of all congenital heart disease. Closure of the fistula is recommended in cases of large dimensions, relevant left–right shunt, or ischaemic events. Thrombosis of the coronary aneurysms may occur as a postoperative complication. Case summary We report a case of a coronary fistula between the circumflex artery and coronary sinus with giant aneurysm. After a failed percutaneous closure attempt, the patient was surgically treated without major postoperative complications. Despite therapeutic anticoagulation and antiplatelet therapy, she presented at clinical follow-up with thrombosis of the dilated coronary artery without signs or symptoms of ischaemia. Discussion Management of coronary artery fistula may be challenging in cases in which initial percutaneous closure is unsuccessful. This particular case also highlights the importance of close follow-up, despite optimal therapy, to detect potentially lethal complications related to the low flow in the dilated coronary aneurysm.

scholarly journals Surgical Repair of Congenital Coronary Artery Fistula With Giant Aneurysm

2020 ◽  
Vol 23 (2) ◽  
pp. E151-E153
Author(s):  
Xiaoyong Li ◽  
Laichun Song ◽  
Huiqiong Guo ◽  
Jing Jin ◽  
Ming Xu
Keyword(s):  
Coronary Artery ◽  
Giant Aneurysm ◽  
Coronary Aneurysm ◽  
Coronary Artery Fistula ◽  
Post Operation ◽  
History Of ◽  
Normal Blood Flow ◽  
Flow Through ◽  
Congenital Coronary Artery Fistula

A 67-year-old man with a 3-year history of dyspnea on exertion arrived to our institution with discontinuous palpitations and short breath. He was diagnosed with congenital coronary artery fistula (CAF). Angiography revealed 3 giant aneurysmal formations and coronary artery calcification. We report a case of successful repair of CAF with a giant coronary aneurysm by closing the orifice and resecting the aneurysm and reconstructing the left coronary artery. The surgical procedure included closure from within a vessel dilated by aneurysm and excision of the aneurysm. We were able to completely obliterate the fistula and preserve the normal blood flow through the coronary arteries post operation. The postoperative course was eventful, but the patient was discharged home. The patient was doing well at his 28-month follow-up visit.

scholarly journals Percutaneous closure of a fistula from the left circumflex coronary artery to the coronary sinus in an infant

2021 ◽  
Vol 49 (6) ◽  
pp. 030006052110217
Author(s):  
Yun Bao ◽  
Tian-Yuan Xiong ◽  
Xiao Li ◽  
Yuan Feng
Keyword(s):  
Coronary Artery ◽  
Coronary Sinus ◽  
Coronary Artery Fistula ◽  
Percutaneous Closure ◽  
Circumflex Coronary Artery ◽  
Vascular Plug ◽  
Left Circumflex Coronary Artery ◽  
Great Vessels ◽  
Rare Situation

Coronary artery fistula is an abnormal direct connection between the coronary artery and any of the four chambers of the heart or great vessels. A fistula from the left circumflex coronary artery to the coronary sinus is a relatively rare situation. We report a case of 12-month-old infant with coronary artery fistula from the left circumflex coronary artery to the coronary sinus that was identified incidentally. The N-terminal pro-brain natriuretic peptide level was elevated. Additionally, the proximal segment of the left circumflex coronary artery was dilated. On the basis of these findings, percutaneous closure of the fistula was performed with a vascular plug. This procedure achieved no residual flow and good hemodynamics were observed during follow-up.

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 Percutaneous closure of coronary artery fistula: long-term follow-up results

2015 ◽  
Vol 4 ◽  
pp. 318-322
Author(s):  
Erdogan Ilkay ◽  
Ozlem Ozcan Celebi ◽  
Fehmi Kacmaz ◽  
Ozcan Ozeke
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Fistula ◽  
Percutaneous Closure ◽  
Long Term Follow Up

scholarly journals 472 Coronary disease in ADPKD patient: a giant coronary aneurysm

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Francesco Della Mora ◽  
Simone Fezzi ◽  
Marta Dal Porto ◽  
Michele Pighi ◽  
Flavio Ribichini
Keyword(s):  
Coronary Artery ◽  
Right Coronary Artery ◽  
Invasive Coronary Angiography ◽  
Previous History ◽  
Giant Aneurysm ◽  
Atherosclerotic Disease ◽  
Circumflex Artery ◽  
Coronary Aneurysms ◽  
Increased Risk ◽  
The Right

Abstract Aims Autosomal dominant polycystic kidney disease (ADPKD) is a monogenic disorder driven by mutation of one of two genes: PKD1, which codifies polycystin-1, and PKD2, which codifies polycystin-2. The mutated proteins determine the formation of multiple renal cysts with a consequent decline in kidney function eventually leading to end-stage renal disease (ESRD). In the last decades the cardiovascular complications of ADPKD are emerging as the leading cause of death, but coronary artery disease (CAD) remains to be an uncommon complication. Methods and results A 60-year-old male patient affected by ADPKD, in dialysis treatment for ESRD, was admitted in 2020 to our hospital for invasive coronary angiography (ICA), checking eligibility for kidney transplantation. He had a previous history of hypertension and chronic ischaemic cardiomyopathy. ICA performed in 2017 for unstable angina assessed ectasiant coronary arteries with diffuse atherosclerotic disease (Figure 1), determining significant stenosis of the proximal left anterior descending artery and proximal circumflex artery, treated with percutaneous coronary intervention (PCI). In 2020 was so repeated ICA, that evidenced a good result of the previous PCI, but pointed out a severe progression of ectasiant disease, which led to formation of giant aneurysm of the proximal tract of the right coronary artery, assessed at 3.8 cm × 2.5 cm (Figure 2), fistulizing to the right atrium and determining significant flow limitation in the following part of the right coronary artery. The absence of any symptoms and the lack of evidence of ongoing heart dysfunction, led our team to indicate conservative management and angiography follow-up. Conclusions Cardiovascular disease is a major cause of morbidity and death in ADPKD, underlying a tendency towards accelerated atherosclerosis, but wide data about coronary involvement are still lacking. ADPKD patients seem to have an increased risk of developing coronary aneurisms, but either due to the expression of mutated proteins in arterial smooth cells, to the accelerated atherosclerotic disease or to the combination of both, is still controversial. Consequently, it is difficult to differentiate the underlying pathophysiology of aneurysm formation in an individual patient and to speculate whether ADPKD patients have an increased risk of developing coronary aneurysms independent of their accelerated atherosclerotic process.

Congenital Left Main Coronary Artery to Coronary Sinus Fistula

2011 ◽  
Vol 14 (4) ◽  
pp. 255 ◽  
Author(s):  
Fotios A. Mitropoulos ◽  
Meletios A. Kanakis ◽  
Periklis A. Davlouros ◽  
George Triantis
Keyword(s):  
Coronary Artery ◽  
Coronary Arteries ◽  
Coronary Sinus ◽  
Left Main Coronary Artery ◽  
Coronary Artery Fistula ◽  
Left Main ◽  
Coronary Fistula ◽  
Excellent Outcome ◽  
Surgical Ligation ◽  
Congenital Coronary Artery Fistula

Congenital coronary artery fistula is an extremely rare anomaly that may involve any of the coronary arteries and any of the cardiac chambers. We report the case of a 14-year-old female patient with a symptomatic congenital coronary fistula starting from the left main coronary artery and draining to the coronary sinus. The patient underwent surgical ligation of the fistula and had an excellent outcome.

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