A Rare case of Coronary A-V Fistula Draining into SVC
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Coronary arteries
Left coronary artery
Lumen (anatomy)
Circumflex
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A coronary artery fistula (CA F) is a direct connection between a coronary artery and any one of the cardiac chambers, the coronary sinus or superior vena cava, or a pulmonary artery or pulmonary vein close to the heart. CAF accounts for 48.7% of all congenital coronary anomalies.1 The most common drainage sites in a decreasing frequency are the right ventricle (41%), right atrium (26%), pulmonary artery (17%), coronary sinus (7%), left atrium (5%), left ventricle (3%) and superior vena cava (1%).2 Further occurrence of this CAF along with the presence of aortic sinus to pulmonary artery fistula is very rare.
We present a case of a 53-year-old, hypertensive man who had presented with a first episode of chest pain of 8 hours’ duration. …
Coronary angiogram
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Neuroradiology
Atrium (architecture)
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We report an extremely rare case of a 14-month-old girl who was diagnosed with a single right coronary artery with coronary artery fistula communicating with the right ventricle and congenital absence of left coronary artery. Angiography showed a dilated and tortuous single right coronary artery draining into the right ventricle, absence of left coronary system, and left ventricular coronary circulation supplied via collateral vessels.
Left coronary artery
Collateral circulation
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A coronary arteriovenous (AV) fistula consists of a communication between a coronary artery and a cardiac chamber, a great artery or the vena cava. It is the most common anomaly that can affect coronary perfusion. Yet bilateral involvement of a coronary fistula, constitutes an uncommon subgroup of coronary AV fistulas. We herein report on a case of bilateral coronary AV fistula that was coexistent with variant angina originating from the distal right ventricular branch of the right coronary artery and the distal septal branch of the left anterior descending artery, and the latter drained into the right ventricle.
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Objective To observe the operative effects of coronary artery fistula. Methods Malformations and operative results of 23 cases with coronary artery fistula were retrospectively analyzed. Results There were 13 cases of fistula of right coronary artery, 9 cases of fistula of left coronary artery, one cases of fistula of two coronary artery; 9 cases of coronary artery fistula opened into right ventricle,6 cases opened into right atrium, 3 cases opened into pulmonary artery, 2 cases opened into the sinus of coronary veins, 2 cases opened into left atrium, 2 cases opened into left ventricle, 3 cases were multiple fistulas. All cases received surgical treatment, excepttion for one cases of multiple fistulas had small residue fistula, the others were better. Conclusion At pressent,the operation treatment is the best method for fistula of coronary artery .
Left coronary artery
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Despite the fact that coronary arteriovenous fistulas constitute approximately half (48%) of coronary artery anomalies, they are rarely seen anomalies. In this report, we aim to present a coronary arteriovenous fistula case detected during a coronary angiography between left anterior descending artery and pulmonary artery.
Main Pulmonary Artery
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To the Editor:
We read with interest the article by Drs. Wong, Chua, and Chan titled Coronary-Pulmonary Arteriovenous Fistula Used as Proximal Anastomotic Site for Saphenous Vein Grafts in Patient with Porcelain Aorta. 1 We too have encountered patients with various coronary anomalies, most recently a 53-year-old man who presented with progressive symptoms of angina, shortness of breath, diaphoresis, and fatigue.
Electrocardiography suggested nonspecific ST segment changes in the anterior leads. Coronary angiography revealed significant triple-vessel disease with well-preserved left ventricular function (ejection fraction, 0.70). Selective angiography of the right coronary artery (RCA) revealed a small but codominant vessel exhibiting an 80% stenosis at its mid-portion, as well as a 60% narrowing at the crux. Selective angiography of the left coronary system demonstrated a fistula arising from the left anterior descending (LAD) coronary artery just proximal to a 50% to 60% lesion. The fistula appeared to empty into the main pulmonary artery (Fig. 1). The circumflex artery was narrowed by 60% proximally, and by 90% more distally near the takeoff of the 2nd obtuse marginal branch. Right heart catheterization revealed normal pulmonary artery pressures (30/16 mmHg), with no step-up in oxygen saturations from right ventricle to pulmonary artery (70.5% vs 72.4%). As a consequence, we postulated that the fistula, although small, produced a “steal” phenomenon that, in addition to the underlying coronary artery disease, contributed to the patient's anterior wall ischemia and chest pain.
Fig. 1 Selective angiography shows a fistula (arrow) arising from the left anterior descending coronary artery and appearing to empty into the main pulmonary artery.
At operation, 3 bypass grafts were constructed: left internal mammary artery to the LAD, reverse saphenous vein to the distal RCA, and reverse saphenous vein to the obtuse marginal branch. Conventional cardiopulmonary bypass was used, including moderate systemic hypothermia, cold blood cardioplegia, and the single aortic cross-clamp technique. Attention was then turned to the coronary fistula, which appeared to be entirely epicardial in nature. At its origin, the fistula arose from the LAD as a superfluous mesh of cirsoid vessels. However, this angiomatous network appeared to converge into a single lumen as it entered the main pulmonary artery. Single 4-0 polypropylene sutures with pledgets were placed around the fistula, proximally and distally. In addition, the fistulous tract was obliterated lengthwise with a running 5-0 polypropylene suture.
Simple ligation of a fistula between a coronary artery and a pulmonary artery was 1st described in 1947 by Biorck and Crafoord. 2 This surgical approach is satisfactory, provided that the fistula is single lumen in nature. If multiple lumens are suspected, or if the sites of origin and termination are not clearly defined, the pulmonary artery should be opened and the fistula closed under direct vision using cardiopulmonary bypass. 3–5 According to de Nef and colleagues, 6 the majority of coronary fistulas that arise from the native RCA empty into the right atrium or right ventricle. Wong, Chua, and Chan's description of a RCA-to-pulmonary artery fistula is a rare find indeed. 1 Furthermore, we applaud their creative use of this anomalous vessel as a proximal anastomotic site in a patient with a porcelain aorta.
Coronary steal
Cardiac catheterization
Coronary arteries
Circumflex
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Background: Single coronary ostium concomitant with coronary artery fistula is a very rare congenital anomaly. Apart from that, the combination of a closed loop of the coronary artery has never been reported. Case presentation: Herein, we present a 7-year-old girl diagnosed as single left coronary ostium with a giant coronary trunk, coronary artery to right ventricle fistula, and coronary artery ring. The coronary fistula was surgically ligated with off-pump strategy and the patient discharged on postoperative day 5 and free of symptoms during the 3 years of follow-up. Conclusion: To our knowledge, the presented congenital coronary anomaly is the first to be reported in the literature with the name of congenital coronary artery ring with single left coronary ostium and fistula.
Ostium
Coronary artery anomaly
Left coronary artery
Coronary arteries
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The authors describe a case of coronary artery fistula seen as a mediastinal mass on a chest radiograph. Such a diagnosis should be considered when a bulge is seen along the left cardiac border on the plain film.
Mediastinal mass
Chest radiograph
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Coronary artery fistulas are rare congenital anomalies of coronary termination. There are 3 types: (1) cameral coronary fistulas, (2) pulmonary coronary fistulas, and (3) bronchial coronary fistulas. Left circumflex coronary artery to left atrial fistula are exceptional. Imaging, especially the CT angiogram, must establish an anatomical classification of the fistula for therapeutic purposes, by specifying its origin, its path, its size and its termination. We report a rare case of the left circumflex coronary artery to left atrial fistula in a 31 year old man, which is an uncommon presentation of coronary termination anomalies. The CT coronary angiogram must describe the origin segment of the fistula and the drainage site which have therapeutic consequences.
Circumflex
Coronary angiogram
Coronary arteries
Presentation (obstetrics)
Left coronary artery
Coronary steal
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