Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014:2014:213673.
doi: 10.1155/2014/213673. Epub 2014 Nov 16.

Coronary Artery Fistulae Discovered during Presentation of a Patient Having Heart Failure due to Severe Aortic Stenosis

Abdulrahman Khalifa Alammar  1
Affiliations

Coronary Artery Fistulae Discovered during Presentation of a Patient Having Heart Failure due to Severe Aortic Stenosis

Abdulrahman Khalifa Alammar. Case Rep Cardiol. 2014.

Abstract

Introduction. Coronary artery fistulae (CAF) are rare defects with abnormal communication between a coronary artery with either a cardiac chamber or another vascular structure, bypassing the myocardial capillary network. We report a rare multiple arterial coronary fistulae with drainage to the right pulmonary artery. Case Presentation. A 56-year-old male was brought to our hospital for work-up of severe aortic stenosis. Further evaluation revealed multiple CAF with abnormal drainage to the right pulmonary artery. He was discharged after aortic valve replacement and closure of the coronary fistula. Conclusion. This case demonstrates that patients with complex CAF and drainage to the right pulmonary artery can remain asymptomatic and diagnosed accidentally during cardiac imaging, presenting particular challenges in both medical and surgical treatment.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Echocardiography, continuous-wave spectral Doppler across the aortic valve showed severe aortic stenosis with mean gradient 70 mmHg and peak gradient 105 mmHg.
Figure 2
Figure 2
(a) Still-frame image of late filling of coronary angiogram to left system with selective engagment of the LAD showed LM fistula (black arrows) which join the fistuous vessel of the other coronary artery and then drainage to the right pulmonary artery (RPA). (b) Still-frame image of cornonary angiogram to left system with selective engagement of the LCX and LM fistula (black arrow) fistolous vessel fills from the LCX (red arrow). (c) Still-frame image of cornonary angiogram of the RCA shows the fistolous vessel fills from RCA. (d) The same injection with late filling shows the fistula drainge to RPA. LAD: left anterior descending. LCX: left cercumflex. LM: left main. RAC: right coronary artery. RPA:right pulmonary artery.
Figure 3
Figure 3
(a) Volume rendering CTA showed LM fistula joining the fistulous vessel of the other coronary arteries draining into the RPA. (b) Curved MPR showed the insertion point of the fistula at RPA. LAD: left anterior descending artery. LPV: left pulmonary vein. LA: left atrium.
See this image and copyright information in PMC

References

    1. Cabarrus B., Khan N. U., Shammas R. L. Large spontaneous coronary artery-to-right ventricular fistula. Journal of Invasive Cardiology. 2006;18(12):E288–E291. - PubMed
    1. Qureshi S. A. Coronary arterial fistulas. Orphanet Journal of Rare Diseases. 2006;1(1, article 51) doi: 10.1186/1750-1172-1-51. - DOI - PMC - PubMed
    1. Skimming J. W., Walls J. T. Congenital coronary artery fistula suggesting a “steal phenomenon” in a neonate. Pediatric Cardiology. 1993;14(3):174–175. doi: 10.1007/BF00795649. - DOI - PubMed
    1. Ramo O. J., Totterman K. J., Harjula A. L. J. Thrombosed coronary artery fistula as a cause of paroxysmal atrial fibrillation and ventricular arrhythmia. Cardiovascular Surgery. 1994;2(6):720–722. - PubMed
    1. Lowe J. E., Adams D. H., Cummings R. G., Wesly R. L., Phillips H. R. The natural history and recommended management of patients with traumatic coronary artery fistulas. Annals of Thoracic Surgery. 1983;36(3):295–305. doi: 10.1016/S0003-4975(10)60132-4. - DOI - PubMed

LinkOut - more resources