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Review
. 2020 Feb 3;15(1):32.
doi: 10.1186/s13019-020-1073-x.

The role of the fractional flow reserve in the coronary steal phenomenon evaluation caused by the coronary-pulmonary fistulas: case report and review of the literature

Zhiwei Huang  1 , Zhihong Liu  1 , Shaodong Ye  2
Affiliations
Review

The role of the fractional flow reserve in the coronary steal phenomenon evaluation caused by the coronary-pulmonary fistulas: case report and review of the literature

Zhiwei Huang et al. J Cardiothorac Surg. .

Abstract

Background: Congenital coronary-pulmonary fistulas (CPFs) are commonly unilateral; however, bilateral and multilateral fistulas are relatively rare. The steal phenomenon aroused from bilateral or multilateral CPFs, and was uncertain and seldom reported. We possess a new tool to assess the hemodynamic significance of coronary artery fistulas. This study aimed to describe the clinical presentation, diagnostic modalities, and management of the coincidentally detected congenital bilateral CPFs.

Case presentation: A case of a 52 year-old female with 10 years history of typical palpitations and chest tightness was presented. The selective coronary arteriography showed a right dominant coronary circulation without significant stenosis; however, with anomalous vessels originating from the proximal right and left anterior descending coronary arteries, draining into the pulmonary artery through a plexus of small vessels. We introduced the fractional flow reserve (FFR) to evaluate the hemodynamic significance of CPFs. The patient was successfully treated with coil embolization.

Conclusions: We presented the case of a female with typical palpitations and chest tightness due to the steal phenomenon that aroused from bilateral CPFs. The fistulas were safely and successfully closed by coil embolization. We showed a new tool for the sophisticated evaluation of the hemodynamic significance of CPFs using FFR measurement and temporary occlusion of the fistula with a standard balloon. FFR could be a promising means for the treatment of decision making of the CPFs.

Keywords: Coronary arteriography; Coronary-pulmonary artery fistulas; Fractional flow reserve.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
a Coronary angiography demonstrating a coronary artery fistula between the right coronary artery (RCA) and the pulmonary artery (PA) by white arrows. b Coronary angiography demonstrating a coronary artery fistula between the left anterior descending artery (LAD) and the main pulmonary artery by small white arrows. Moreover, coronary angiography demonstrating a poor development of the distal LAD by bold white arrows. c Shunt between the RCA and PA is blocked by coil embolization (black arrow). d Shunt between the LAD and PA is blocked by coil embolization (black arrow)
Fig. 2
Fig. 2
a. The FFR of preoperaton in the LAD. b. The FFR of postoperaton in the LAD
See this image and copyright information in PMC

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