Triple Vessel Coronary Cameral Fistula: A Rare Case of Angina.
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ABSTRACT:
SUBMITTER: Agrawal D
PROVIDER: S-EPMC7316565 | biostudies-literature | 2020 Jul
REPOSITORIES: biostudies-literature
Publications
Triple Vessel Coronary Cameral Fistula: A Rare Case of Angina.
Agrawal Deepak D Garg Ashok A Sharma G L GL
Journal of cardiovascular imaging 20191216 3
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Project description:RationaleA coronary artery fistula (CAF) is an anomalous communication between a coronary artery and a cardiac chamber or great vessel. It is a rare congenital anomaly that is often small and asymptomatic, occurring in only 0.002% of the general population. Most CAFs originate from the right coronary artery and flow into the right cardiac system. Although extremely rare, some cases may originate from the bilateral coronary arteries and flow into the left ventricle.Patient concernsHerein, we report a rare case of a 55-year-old male smoker with no history of heart disease or cardiac surgery, who presented with a 5-year history of recurrent chest congestion, palpitations, and shortness of breath. On physical examination, his heart and lungs revealed normal findings without cardiac murmurs and no systemic or pulmonary edema. Moreover, 24-hour ambulatory electrocardiography showed no signs of ischemia but exhibited a short array of ventricular tachycardia and short atrial tachycardia. Chest computed tomography showed left apical emphysema without cardiomegaly and pulmonary congestion. Furthermore, coronary angiography revealed dual congenital coronary cameral fistula, a complex CAF with a left circumflex artery-left ventricle fistula and a right coronary artery-left ventricle fistula, complicated with a myocardial bridge.Diagnosis and interventionsA diagnosis of left circumflex artery-left ventricle fistula complicated with a right coronary artery-left ventricle fistula and myocardial bridge was made. Since the patient refused surgery, medical management with enteric-coated aspirin, sustained-release metoprolol, and atorvastatin calcium was initiated.Outcomes and lessonCurrently, the patient is now asymptomatic and in good condition since 6 months after undergoing conservative treatment with β-blockers.
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Project description:Coronary cameral fistulas (CCFs) are rare arteriovenous malformations that may be congenital or acquired. The presentation of CCFs varies from asymptomatic in early age to symptomatic and start of complications upon aging. Although percutaneous closure with embolization can also be done, surgical closure of CCFs is a gold standard of treatment. We present the case of a 20-year-old patient with a fistula connecting right coronary artery and the right atrium, along with aortic valve endocarditis and congestive cardiac failure.
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Project description:Coronary cameral fistulas are abnormal communications between a coronary artery and a heart chamber or a great vessel which are reported in less than 0.1% of patients undergoing diagnostic coronary angiography. All three major coronary arteries are even less frequently involved in fistula formation as it is the case in our patient. A 68-year-old woman was admitted to cardiology clinic with complaints of exertional dyspnea and angina for two years and a new onset palpitation. Standard 12-lead electrocardiogram revealed atrial fibrillation (AF) with a ventricular rate of 114 beat/minute and accompanying T wave abnormalities and minimal ST-depression on lateral derivations. Transthoracic echocardiographic examination was normal except for diastolic dysfunction, minimally mitral regurgitation, and mild to moderate enlargement of the left atrium. Sinus rhythm was achieved by medical cardioversion with amiodarone infusion. Coronary angiography revealed diffuse and multiple coronary-left ventricle fistulas originating from the distal segments of both left and right coronary arterial systems without any stenosis in epicardial coronary arteries. The patient's symptoms resolved almost completely with medical therapy. High volume shunts via coronary artery to left ventricular microfistulas may lead to increased volume overload and subsequent increase in end-diastolic pressure of the left ventricle and may cause left atrial enlargement.
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Project description:Left atrial myxoma is the common benign tumor of heart. Coronary arteries may supply these tumor. Considering the vascular nature of the tumor, acquired coronary cameral fistula(CCF) can be a possibility postexcision of the left atrial myxoma. Here, we discuss a case of 53-year-old female patient, who developed acquired CCF, following excision of the tumor and the role of transesophageal echocardiography intraoperatively in diagnosis.
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Project description:Coronary-cameral fistulas (CCFs) are mostly congenital in origin and rarely acquired. Clinical symptoms are decided by the hemodynamic significance of the coronary fistula. Even in asymptomatic patients, it is essential to know about coronary CCF particularly if the patient is to undergo cardiac surgery with cardioplegic cardiac arrest. Incidental finding of coronary CCF should never be ignored. Intraoperative myocardial protection and methods used are significantly influenced by such fistula.
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Project description:A patient presenting with worsening dyspnea and left-sided chest pain underwent heart catheterization, found to have a rare connection between the right and left coronary arteries draining into the left ventricle, consistent with dual coronary-cameral fistula.
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Project description:BackgroundAcquired coronary cameral fistula is an extremely rare condition that involves an abnormal communication between a coronary artery and a cardiac chamber. It usually occurs after chest trauma or cardiovascular interventions, such as percutaneous coronary intervention (PCI) and is associated with various outcomes, ranging from a stable status to haemodynamic instability. Acquired coronary cameral fistula frequently arises from the right coronary artery and drains generally into the right ventricle.Case summaryWe report the unusual case of a 56-year-old male patient referred to an invasive cardiology centre for a suspected left anterior descending (LAD) coronary-left ventricular (LV) fistula resulting from a primary PCI for an anterior ST-elevation myocardial infarction. Here, the confirmed LAD-LV fistula was successfully treated by retrograde PCI with covered stent implantation. Clinical and angiographic outcomes were favourable at 1-month follow-up.DiscussionCoronary cameral fistula can be a severe complication of primary PCI. Various treatment strategies can be considered based on haemodynamic status and anatomical features. In the case described herein, the use of a retrograde approach led to permanent fistula closure and complete revascularization.
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