Most of these fistulae are congenital and solitary, although they can be acquired and multiple. Coronary fistula with pulmonary atresia and intact. Pdf giant right coronary artery aneurysm associated with. Surgical treatment of a coronary cameral fistula secondary to percutaneous coronary intervention. Coronarycameral fistula connecting the left anterior descending. A coronary cameral fistula ccf is a rare anomalous connection between a coronary artery and a cardiac chamber. Significance of congenital coronary artery fistulas. These may either be multiple microfistulae or solitary macro fistula. Multiple coronary cameral fistulae the british journal of. We report a patient who presented with coronary cameral fistula from left main coronary artery lca, which had spontaneously closed by the presence of clots and debris at the distal end of the fistula, with associated severe aortic regurgitation and vegetations in aortic valve.
Coronary cameral fistulas ccf are anomalous connections between one or more coronary arteries and a cardiac chamber, most commonly the right ventricle or right atrium. The patient underwent percutaneous coronary intervention pci with revascularization of the proximal rca with a 2. When symptomatic, treatment options include surgical management with ligation andor patch closure or tr. Coronary artery to left ventricle fistula cardiovascular. Angiography remains the best investigation for diagnosing the disease. Pathology it can occur from a number of causes which include. Coronary cameral fistulae a scarce entity lupine publishers. Hemodynamic significance of coronary cameral fistula assessed.
However, transient electrocardiographic changes, arrhythmias, and fistula dissection are potential complications with coil embolization and transcatheter closure strategies. Methods medical records of all patients with caf who underwent transcatheter. Saboo 1, yuhsiang juan 1,2, ashish khandelwal 1, elizabeth george 1, michael l. Coronary artery fistulae are observed at an incidence of 0. The murmur was fine, but they found a coronary artery fistula, which they described as an incidental finding because it was likely only diagnosed because we were checking for the murmur. Percutaneous closure of congenital coronary artery fistulae. The first case is a rare form of caf in which the left circumflex coronary artery fistula empty into left ventricle. Significance of congenital coronary artery fistulas congenital coronary artery fistulas cafs are anomalous terminations of coronary arteries in cardiac chambers or great arteries created by bypassing the myocardial capillary bed. Coronarycameral fistulas ccfs are mostly congenital in origin and rarely acquired.
If the avf or avg has problems andor the avf has not matured within a 6 week timeframe andor is difficult to cannulate, consult physician or va coordinator. In some cases, infants who are born with this condition may also have other heart defects. Medical college, ahmedabad, india although coronary arterial. This paper describes three cases of caf along with their initial presentation, imaging findings and management. Clinical features of coronary artery fistula and exercises. Pdf surgical treatment of a coronarycameral fistula. Here, we report a rare case of cameral fistula in which a left and a right. Most commonly, the implicating artery is the right coronary artery in 52% or left anterior descending coronary artery lad in 32% of cases, with drainage into the right side of the heart in over 90%. Mdct of congenital coronary artery fistulas sachin s. Traumatic coronary artery cameral fistulas listed as tcaf. Coronary cameral fistulas ccfs are rare and are characterized by abnormal communication between coronary artery ca and cardiac chamber that usually results from aberrancy of normal embryological development. Coronary artery fistulae caf are rare congenital or acquired in which a connection forms between one of the coronary arteries and a heart chamber or with other vessels. The left circumflex was significantly dilated with the obtuse marginal coronary artery draining into the left ventricle via the coronarycameral fistula figure 3. Coronary cameral fistula is a rare clinical entity and can be acquired during an individuals lifetime.
Coronary artery fistulas are rare anomalies, their incidence range from 0. Transcatheter occlusion of giant congenital coronary. A coronary cameral fistula ccf is a rare anomalous connection between a coronary artery and a cardiac chamber ccfs are defined as single or multiple, small or large direct communications that arise from one or more coronary arteries and enter one of the four cardiac chambers of patients diagnosed with solitary ccf, 40% have arterial. It is usually congenital and asymptomatic in majority of patients. Secondary prevention medications after coronary artery bypass grafting. Coronarycameral fistula with angina pectoris europe pmc. They do not usually cause symptoms or complications in the. Multiple coronarycameral fistulae europe pmc article. Coronary arterial fistulas orphanet journal of rare. Pci and surgery for complex cad and cameral fistulas. Perioperative implications of coronarycameral fistula raut ms. Most of ccfs are discovered incidentally during angiographic evaluation for coronary vascular disorder. Unless very large and hemodynamically significant, it is usually. Coronary cameral fistulas are rare congenital malformations, often incidentally found during cardiac catheterizations.
Case report multiple multilateral coronary cameral fistulae in a patient with minor cardiac venous system darkomarkota, 1 zrinkoprskalo, 1 ivicamarkota, 1 borisstarcevic, 2 josipmaskovic, 3 monikatomic, 1 andivicabrizic 1 department of cardiology, university hospital mostar, bijeli brijeg bb, mostar, bosnia and herzegovina. A coronary artery fistula is a communication existing between a coronary artery and a cardiac chamber or systemic vein. A 68yearold woman was admitted to cardiology clinic. A coloenteric fistula is a type of gastrointestinal fistulation wherein there is abnormal communication between the colon and the small bowel. Diagnostic coronary angiography demonstrated a right dominant system. The high flow of blood in the larger branch, however, prevented conventional occlusion using coils. Transcatheter occlusion of a large coronary arterial fistula. A fistula can be present with or without an abscess and may connect just to the skin of the buttocks near the anal opening. To delineate the characteristics of congenital first part and acquired second part ccfs in adults, a pubmed search was conducted for papers dealing with congenital or acquired ccfs. Perform a complete physical assessment of the av fistula and document the findings. The operator should read the instructions prior to use. Methods medical records of all patients with caf who underwent transcatheter closure. Coronarycameral fistulas are rare congenital malformations, often incidentally found during cardiac catheterizations.
We report a case of a coronary artery fistula between the left circumflex coronary artery and the right and left atria. Giant right coronary artery aneurysm associated with coronary cameral fistula. Fistula av arteriovenous fistula a surgical connection between and artery and a vein beneath the skin of an arm or leg to provide access to the blood. Acquired coronary cameral fistula due to post stent. An 18yearold boy presented with features of right heart volume overload. Coronary artery fistula the annals of thoracic surgery. Coronary angiographic projection showing a coronary cameral fistula arising from the left circumflex artery and draining into the left ventricle.
Coronary cameral fistula is a rare entity and is characterized by an abnormal communication between coronary artery and a cardiac chamber. Coronary artery fistulae caf are classified as abnormalities of a chamber of the heart coronary cameral fistula or any segment of the. The fistula is a tunnel that forms under the skin and connects the infected glands to the abscess. Three vessel coronary cameral fistulae associated with new. There can be considerable variation in the course of a coronary artery fistula. Surgical repair of anomalous aortic origin of a coronary artery. A coronary cameral fistula was found in the anterior descending artery to the left ventricle. An ecg showed sinus rhythm and t inversion over lateral leads. In this case, the diagnosis was established by conventional coronary angiography, though the coronary anatomy may alternatively be delineated using computed tomography coronary angiography. Coronary artery fistula caf, an uncommon occurrence, is more often than not congenital in origin. Coronary artery fistulae are communication between coronary arteries and other structures like cardiac chamber coronary cameral fistula or a vein coronary arteriovenous fistula. Cafs are the second most common coronary anomaly after coronary artery origin anomalies 1.
Coronary cameral fistula treated by the amplatzer vascular. Introduction the patient is a fiftyyearold female with a past medical history notable for congestive heart failure, hypertension and hyperlipidemia. Your story matters citation nagpal, prashant, ashish khandelwal, sachins saboo, gunjan garg, and michaell steigner. Coronary cameral fistulas are an uncommon entity, the etiology of which may be congenital or traumatic.
This is a rare defect and usually occurs in isolation. The coronary arteries are blood vessels that bring oxygenrich blood to the heart. An extremely tortuous coronary fistula forming multiple loops was observed. Multiple coronary cameral fistulae the british journal. Medisystems standard av fistula needles this reference sheet does not replace the instructions for use enclosed in the av fistula needle with masterguard package. The smaller branch could be embolised with three detachable platinum microcoils without problems. A rare finding abdulmannankhanminhas,1 ehteshamulhaq,2 ahmedarslanyousufawan,3 arshadameerkhan,4 ghazanfarqureshi,5 andpragathibalakrishna1 1orangeparkmedicalcenter,orangepark,fl,usa 2universityofsouthalabama. Dec 21, 2006 a coronary arterial fistula is a connection between one or more of the coronary arteries and a cardiac chamber or great vessel.
It may occur isolated or along with congenital heart diseases. Coronary cameral fistulas commonly originate from the rca 55%, the lad 35%, or both of these arteries 45. With the advent of multidetector rows and 3d reconstruction, multidetector computed tomography has emerged as the modality of choice in the delineation of the complex coronary anatomy and diagnosis of coronary artery anomalies, helping in the institution of appropriate therapy. Hybrid approach to closure of an acquired coronary cameral fistula. Coronary cameral fistula, defined as the entry of a coronary artery into any of the cardiac chambers, is considered the most common type of caf detected with coronary angiography 19,42. Case report three vessel coronary cameral fistulae associated. The left circumflex coronary artery lcx fistula draining into the coronary sinus cs is a less common form, and most cases described in the literature were adult cases. Angiographic still rao cranial demonstrating left anterior descending lad draining to the right ventricle rv five months later, the patient reported continuing onoff episodes of minimal exertional shortness of breath and intermittent atypical chest pain. Coronary arterial fistula most commonly affects the right side of the heart. The majority of these fistulas are congenital in nature but can be acquired secondary to trauma or invasive cardiac procedures. The capillary blood flow drains into the venules, which merge to form. Anomalous aortic origin of a coronary artery aaoca is a rare congenital heart defect that. Objectives this study sought to assess clinical and angiographic outcomes in a series of 29 patients who underwent transcatheter closure of coronary artery fistulae caf.
Other situations that can result in a fistula include crohns disease, radiation, trauma and malignancy. Percutaneous closure of congenital coronary artery. Coronary artery fistulas cafs are classified as the anomalies of termination and are considered a major congenital anomaly and are in the subgroup of acyanotic heart disease. The force of blood flowing from the artery makes the vein larger and thicker. Jan 27, 2015 a coronary artery fistula is suspected following detection of a continuous murmur upon routine examination. All three major coronary arteries are even less frequently involved in fistula formation as it is the case in our patient. Percutaneous closure of right coronary artery to the left. Aortocaval fistula is a rare and devastating complication of abdominal aortic aneurysm aaa, wherein the aneurysm erodes into the inferior vena cava.
Left circumflex coronary artery to coronary sinus fistula. Traumatic coronary arterycameral fistulas how is traumatic. Nkya, greenwood sinyangwe and farirai fani takawira abstract background. Upon clinical examination, the murmur is suggestive of patent ductus arteriosus but is heard lower on the sternal border than usual. A coronary cameral fistula is a rare connection between a coronary artery and a cardiac chamber or vein bypassing the cardiac capillary bed system. Cardiac nuclear magnetic resonance was requested as a. Coronary cameral fistulas are abnormal communications between a coronary artery and a heart chamber or a great vessel which are reported in less than 0. Get a printable copy pdf file of the complete article 3. They are vascular communications between the coronary arteries and other cardiac structures, either cardiac chambers or great vessels. Although coronary arterial fistula is rare, it is one of the most common among the coronary artery anomalies. Establishing constantsites in native av fistulae using.
A 10yearold black south african boy presented with a longstanding history of fatigue. Case report multiple multilateral coronarycameral fistulae. Coronary artery fistula, coronary cameral fistula, arteriovenous fistula 1 introduction coronary fistulae are rare anomalies that connect the coronary artery to either a cardiac chamber, known as a coronary cameral fistula ccf, or any of the great vessels coronary sinus, pulmonary artery, superior vena cava or pulmonary. The right coronary artery is dilated and thick walled along nearly its entire length. Coronarycameral fistula treated with coil embolization. Secondary prevention medications after coronary artery bypass. Hybrid approach to closure of an acquired coronarycameral. Coronary cameral fistula is a rare congenital cardiac abnormality. Introduction coronary artery anomalies occur in less than one percent of the general population 1. We describe a case of female patient with severe aortic stenosis and interventricular septal hypertrophy that underwent bioprosthetic aortic valve. A 57 year old male smoker, with a long history of hypertension, presented with angina.
Coronarycameral fistula connecting the left anterior. The huge and tortuous left anterior descending and circumflex arteries merged at the end of their course forming a large coronaryleft ventricular. In december of 2011, she sustained a myocardial infarction and received a 2. Coronary artery perforation, coronary cameral fistula, ellis type 4 perforation, covered stent 1. A coronary artery fistula having connection between 2 coronary. Due to continued dyspnea on exertion, the patient underwent planned coil embolization of the right am coronary cameral fistula. A coronary artery fistula involves a sizeable communication between one of the coronary arteries and a cardiac chamber coronary cameral fistula or a vein coronary arteriovenous fistula. Most of these fistulae are congenital and solitary, although they. Acquired coronary cameral fistula a report of two cases. We report a 17 year old boy with a large fistula from the right coronary artery to the right ventricle. They involve abnormal termination of a coronary artery, usually the right coronary, into a cardiac chamber, usually the right ventricle. The puzzling presentation in our first patient is unique because ccf was acquired despite lack of previous instrumentation or trauma to the right coronary artery.
Coronarycameral fistula ccf is an anomalous connection between a coronary artery and cardiac chamber. Coronary cameral fistula connecting the left anterior descending artery and the first obtuse marginal artery to the left ventricle. We present a case of 45yearold male who presented with anginal chest pain and. A coronary artery fistula can affect how well the blood flows to the heart and lead to dilation of the coronary artery. May 23, 2014 coronary artery anomalies occur in less than 1 % of the general population. Coronary artery fistula related to dilatation of totally occluded vessel. Coronary artery fistula is an abnormal direct connection between a coronary artery and either a cardiac chamber coronary cameral fistula or a vein coronary arteriovenous fistula. This four chamber view of a heart with pulmonary atresia and intact ventricular septum demonstrates a hypoplastic right ventricle hrv with a right coronary artery rca to right ventricular rv fistula. Selective coronary arteriography revealed diffuse ccf involving the left anterior descending artery lad emptying into left ventricle lv. These fistulas most commonly originate in the right coronary artery and terminate into the right ventricle and least frequently drain into the left. Unusual presentation of a coronary cameral fistula springerlink. Thetermcoronary arteriovenous aneurysm can thus be reserved for communications between the coronary artery and the coronaryveins or sinus. Abstract isolated coronary artery fistula in the newborn is a very rare congenital anomaly.
The utility of intraoperative angiography vassileva. We present a 20 day old baby with coronary cameral fistula of the right coronary. Clinical examination was suggestive of hyperdynamic. Conflict of interests e authors declare that there is no con ict of interests regarding the publication of this paper. Background transcatheter closure of caf has become an alternative to surgical closure, but the reported experience is relatively limited. Coronary artery fistula is an abnormal connection between one of the coronary arteries and a heart chamber or another blood vessel. The majority of these fistulas are congenital in origin although they may occasionally be detected after cardiac surgery. Epidemiology spontaneous rupture of an abdominal aortic aneurysm into the adjacent inferior. Coronary cameral fistulas ccf are rare and fascinating anomalies found in approximately 0. A coronary angiogram panel a showed normal left anterior descending lad and circumflex arteries. Acquired coronary artery fistulas ccfs are infrequently detected during conventional coronary angiography. Left coronarycameral fistula presenting with congestive. Cameral fistula in a case of single coronary artery. If symptomatic the patients usually present in childhood.
780 659 165 309 560 900 148 1214 766 366 1221 252 447 33 1085 868 167 994 975 1551 210 1179 573 1271 538 1508 42 299 86 2 1283 933 800 6 885 909 31 564 1077 1021 51 267 876 37