CORONARY ARTERY FISTULA, WHERE ARE WE NOW?''

In the study “Long-term outcomes following surgical repair of coronary artery fistula in adults”, Wada and associates, retrospectively evaluated 13 consecutive patients that underwent surgical repair of CAF No deaths, significant ST-T changes or CAF-related events were reported in a follow-up period of 66.2 months, and 1 patient showed poor contrast RCA#2 on postoperative coronary CT with a myocardial scintigraphy showing no significant change compared to the preoperative state Coronary artery fistulas (CAF) are rare congenital or acquired malformations in the connection of the coronary vessels, first described by Krause in 1865 (2). They can be classified as coronary-cameral fistulas, which connect coronary arteries with any of the heart chambers, or coronary artery malformations, which connect coronary arteries with systemic or pulmonary vessels. Congenital CAFs are normally a result of abnormal embryological development, acquired CAFs are commonly a result of cardiac traumatic injuries, and iatrogenic CAFs are usually a result of interventional cardiac procedures. This condition is still highly undiagnosed, as around 75% of incidentally-found CAFs are small and clinically silent, but it is estimated that CAFs are present in about 0.9% of the general population In our experience, we have a CAF incidence of 0.05% in 10,000 cardiac surgeries, which have demonstrated beneficial outcomes of the surgical repair of CAFs in adults . Authors of this article must be congratulated for the successful development of the study and for the contributions to the literature on this rare condition

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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.

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Congenital Left Main Coronary Artery to Coronary Sinus Fistula

The Heart Surgery Forum ◽

10.1532/hsf98.20101085 ◽

2011 ◽

Vol 14 (4) ◽

pp. 255 ◽

Cited By ~ 4

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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Surgical Repair of Coronary Artery Fistulas with a Giant Coronary Artery Aneurysm Dilated from Valsalva Sinus

Japanese Journal of Cardiovascular Surgery ◽

10.4326/jjcvs.40.58 ◽

2011 ◽

Vol 40 (2) ◽

pp. 58-61 ◽

Cited By ~ 1

Author(s):

Nanae Nishiki ◽

Akiyuki Takahashi ◽

Masahiro Dohi ◽

Taiji Watanabe ◽

Osamu Sakai ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Aneurysm ◽

Surgical Repair ◽

Artery Aneurysm ◽

Coronary Artery Fistulas ◽

Giant Coronary Artery Aneurysm

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A CADAVERIC STUDY ON CORONARY ARTERY VARIATIONS AND ITS CLINICAL `SIGNIFICANCE

10.36106/ijsr/6023902 ◽

2021 ◽

pp. 20-22

Author(s):

Sony Jhansi Priya ◽

Sangeetha A ◽

M. Sai Krishna

Keyword(s):

Coronary Artery ◽

Coronary Arteries ◽

Left Coronary Artery ◽

Coronary Vessels ◽

Average Diameter ◽

Cadaveric Study ◽

Aortic Sinus ◽

Clinical Procedures ◽

Human Cadavers ◽

The Right

Coronary artery variations are one of the commonest variations observed during clinical procedures. Normally, there are two main coronary arteries, the right coronary artery (RCA), left coronary artery (LCA).Left coronary artery gives two important branches left circumex artery (LCX) and left anterior descending (LAD) arteries. Knowledge about the coronary vessels and its variations are essential to clinicians to prevent untoward injury of vessels during any procedures. To study the morphology and variations of coronar Aim: y arteries by dissection. Materials and Methods: The present study was a cadaveric study which was conducted on 50 hearts obtained from adult human cadavers. Coronary arteries were dissected to see the origin, course and variations. The data was entered in Microsoft excel sheet and expressed in percentage. The Right Results: coronary artery branched out from the right aortic sinus and had an average diameter of 3.5mm. The left coronary artery arouse from left aortic sinus and had an average diameter of 4mm. LMCA divided into two branches in 60 percent, three branches in 30 percent and four branches in 06 percent of the hearts and direct branches from left aortic sinuus in 4 percent hearts.Based on the origin of Posterior descending or interventricular artery, Right dominance was observed in 68 percent, left dominance in 26 percent, and equal dominance in 06 percent of the hearts. Conclusion: Knowledge about the variations of coronary vessels is a prerequisite for clinicians to perform interventions of coronary vessels.

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P873Plasma PCSK9 levels and atherosclerosis burden in the coronary arteries of patients undergoing coronary angiography

European Heart Journal ◽

10.1093/eurheartj/ehz747.0470 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

Y Panahi ◽

M S Ghahrodi ◽

M S Jamshir ◽

M A Safarpour ◽

M Pirro ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Angiography ◽

Coronary Arteries ◽

Coronary Stenosis ◽

Coronary Vessels ◽

Cross Sectional Study ◽

Cross Sectional ◽

Vessel Disease ◽

Coronary Calcifications ◽

Triple Vessel Disease

Abstract Background Plasma PCSK9 levels, a novel and effective therapeutic target for CVD prevention, have been associated with CVD events irrespective of traditional risk factors. Whether PCSK9 levels predict coronary artery disease (CAD) burden and severity is a matter of dispute. Purpose To investigate the association between plasma PCSK9 levels and CAD characteristics, including number of major diseased vessels, severity of coronary stenosis, and the burden of coronary calcifications. Methods One hundred and one patients undergoing coronary angiography were recruited for this cross-sectional study. The number of major coronary diseased vessels was defined as the presence of ≥1 stenoses ≥50% in diameter of at least one major coronary artery. CAD severity was defined as either the absence of coronary stenosis (no-CAD), CAD<50% or CAD≥50% in one or more coronary arteries. The burden of coronary calcifications was estimated by angiography visual inspection and classified as absent, mild, moderate or severe. Results Coronary angiography showed single, double and triple vessel disease in 26 (25.7%), 23 (22.8%) and 21 (20.8%) patients, respectively; 20 (19.8%) and 11 (10.9%) pts had either minimal CAD (<50%) or normal angiographic findings. Also, calcifications were absent in 65 patients (64.4%), and mild, moderate and severe in 23 (22.8%), 11 (10.9%) and 2 (2%) patients, respectively. Plasma PCSK9 levels were significantly associated with age (rho=0.22, p=0.025) and SBP (rho=0.21, p=0.034), and were almost doubled in patients with chronic kidney disease (CKD) as compared to those without CKD [164.6 ng/mL (104.6–187.0) vs 94.8 ng/mL (86.8–114.9), p=0.006]. Among patients without CKD, those with CAD≥50% had higher plasma PCSK9 levels than those without [97.1 ng/mL (87.8–143.0) vs 83.2 ng/mL (73.4–102.6), p=0.04]. In the overall population, higher plasma PCSK9 levels were found in pts with triple vessel disease [165.7 ng/mL (121.3–180.5)] than in those with double/single vessel involvement [97.9 ng/mL (87.6–99.8) and 88.4 ng/mL (87.3–97.4), p<0.001 for both comparisons] or without CAD [87.5 ng/mL (74.3–114.9), p<0.001]. Also, a trend toward an increase of plasma PCSK9 levels was found with higher CAD severity [no-CAD: 87.5 ng/mL (74.3–114.9), CAD<50%: 89.1 ng/mL (78.9–105.3), CAD≥50%: 97.6 ng/mL (87.9–155.3), p=0.051], which turned significant after exclusion of CKD patients (p=0.042). Adjustment for age, sex, plasma LDL-cholesterol levels, statin use and CKD abolished the association between PCSK9 and CAD severity but not with the number of significantly diseased vessels and the burden of coronary calcifications. Conclusions Circulating PCSK9, whose plasma levels are significantly influenced by the presence of CKD, discriminates patients with significant coronary artery stenosis from those without CAD. In addition, both the number of diseased coronary vessels and total coronary calcifications are independently predicted by an elevated plasma PCSK9 level. Acknowledgement/Funding None

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Identification of non-obstructive coronary artery disease by coronary CT angiography in patients with normal coronary arteries in preceding invasive catheterization

European Heart Journal ◽

10.1093/eurheartj/eht310.p4695 ◽

2013 ◽

Vol 34 (suppl 1) ◽

pp. P4695-P4695

Author(s):

D. Bittner ◽

L. Klinghammer ◽

J. Schmid ◽

C. Layritz ◽

S. Achenbach ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Ct Angiography ◽

Coronary Arteries ◽

Coronary Ct Angiography ◽

Obstructive Coronary Artery Disease ◽

Normal Coronary Arteries ◽

Coronary Ct ◽

Artery Disease

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An aneurysmal right coronary artery fistula draining into the left ventricle

Cardiology in the Young ◽

10.1017/s1047951117000865 ◽

2017 ◽

Vol 27 (6) ◽

pp. 1214-1215

Author(s):

Dongxu Li ◽

Yabo Wang ◽

Qi An

Keyword(s):

Coronary Artery ◽

Left Ventricle ◽

Right Coronary Artery ◽

Rare Case ◽

Median Sternotomy ◽

Coronary Artery Fistula ◽

Ct Images ◽

Coronary Ct

AbstractWe describe a rare case of aneurysmal right coronary artery drainage into left ventricle in a 38-year old male with entailed coronary CT images. After median sternotomy surgery, the patient recovered well.

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

Case Reports in Medicine ◽

10.1155/2016/2406250 ◽

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.

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

Cardiology in the Young ◽

10.1017/s1047951115001535 ◽

2015 ◽

Vol 26 (5) ◽

pp. 915-920 ◽

Cited By ~ 5

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.

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