Coronary fistula from left main stem to main pulmonary artery.
ABSTRACT We describe a patient with a rare coronary arteriovenous fistula connecting the left main stem to the main pulmonary artery. This rare case was discovered during routine coronary angiography for the evaluation of the patient s coronary heart disease.
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ABSTRACT: Coronary artery fistulas are abnormal communications between a coronary artery and a cardiac chamber or a major vessel (vena cava, pulmonary vein, pulmonary artery). They are usually diagnosed by coronary arteriography. Clinical presentations are variable depending on the type of fistula, shunt volume, site of the shunt, and presence of other cardiac conditions. This report describes a 46-year-old Greek female patient who was admitted to the hospital because of an acute coronary syndrome. She underwent coronary angiogram which showed a coronary artery fistula from the left anterior descending artery to the main pulmonary artery and severe coronary disease. The patient was referred for coronary artery bypass surgery and fistula closure operation. Coronary artery fistulas between left anterior descending artery and main pulmonary artery are very rare anomalies. This case report describes a patient with this anomaly combined with severe coronary disease, reviews the current literature and discusses the available options for treating this rare condition.Cases Journal 02/2010; 3:70.
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ABSTRACT: To describe the characteristics of coronary artery fistulas (CAFs) in adults, including donor vessels and whether termination was cameral or vascular. A PubMed search was performed for articles between 2000 and 2010 to describe the current characteristics of congenital CAFs in adults. A group of 304 adults was collected. Clinical data, presentations, diagnostic modalities, angiographic fistula findings and treatment strategies were gathered and analyzed. With regard to CAF origin, the subjects were tabulated into unilateral, bilateral or multilateral fistulas and compared. The group was stratified into two major subsets according to the mode of termination; coronary-cameral fistulas (CCFs) and coronary-vascular fistulas (CVFs). A comparison was made between the two subsets. Fistula-related major complications [aneurysm formation, infective endocarditis (IE), myocardial infarction (MI), rupture, pericardial effusion (PE) and tamponade] were described. Coronary artery-ventricular multiple micro-fistulas and acquired CAFs were excluded as well as anomalous origin of the coronary arteries from the pulmonary artery (PA). A total of 304 adult subjects (47% male) with congenital CAFs were included. The mean age was 51.4 years (range, 18-86 years), with 20% older than 65 years of age. Dyspnea (31%), chest pain (23%) and angina pectoris (21%) were the prevalent clinical presentations. Continuous cardiac murmur was heard in 82% of the subjects. Of the applied diagnostic modalities, chest X-ray showed an abnormal shadow in 4% of the subjects. The cornerstone in establishing the diagnosis was echocardiography (68%), and conventional contrast coronary angiography (97%). However, multi-slice detector computed tomography was performed in 16%. The unilateral fistula originated from the left in 69% and from the right coronary artery in 31% of the subjects. Most patients (80%) had unilateral fistulas, 18% presented with bilateral fistulas and 2% with multilateral fistulas. Termination into the PA was reported in unilateral (44%), bilateral (73%) and multilateral (75%) fistulas. Fistulas with multiple origins (bilateral and multilateral) terminated more frequently into the PA (29%) than into other sites (10.6%) (P = 0.000). Aneurysmal formation was found in 14% of all subjects. Spontaneous rupture, PE and tamponade were reported in 2% of all subjects. In CCFs, the mean age was 46.2 years whereas in CVFs mean age was 55.6 years (P = 0.003). IE (4%) was exclusively associated with CCFs, while MI (2%) was only found in subjects with CVFs. Surgical ligation was frequently chosen for unilateral (57%), bilateral (51%) and multilateral fistulas (66%), but percutaneous therapeutic embolization (PTE) was increasingly reported (23%, 17% and 17%, respectively). Congenital CAFs are currently detected in elderly patients. Bilateral fistulas are more frequently reported and PTE is more frequently applied as a therapeutic strategy in adults.World Journal of Cardiology (WJC) 08/2011; 3(8):267-77.
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ABSTRACT: Coronary artery aneurysms are noted in 0.15% to 4.9% of patients undergoing coronary angiography. Atherosclerosis accounts for 50% of coronary aneurysms in adults. 1 We report a 64-year-old female with a huge right coronary artery aneurysm with fistula connecting the aneurysm with the pulmonary artery and a fistula connecting the proximal left anterior descending artery with the pulmonary artery. Surgical resection of the coronary artery aneurysm and suture ligation of the coronary artery fistulas were performed. Pathological examination disclosed aneurysm with focal fibrosis and calcification. The patient presenting shortness of breath and angina-like symptoms caused by a huge right coronary artery aneurysm with compression of right ventricular outflow tract made this case noteworthy. The patient's symptoms resolved after surgical intervention.01/2006;