Case Report

A Case of Coronary Cameral Fistula: When and How to Intervene?

Abstract

Coronary artery fistulas constitute a rare anomaly defined as an abnormal communication between a coronary artery and a great vessel or any cardiac chamber. The majority of these fistulas arise from the right coronary artery and the left anterior descending coronary artery; the circumflex coronary artery is rarely involved.  We present an unusual case of a coronary artery fistula in a middle-aged woman who presented with symptoms of heart failure and abnormal auscultation. Echocardiography and conventional and computed tomography angiography showed that the coronary fistula originated from the left circumflex coronary artery and drained majorly into the right ventricle. Given the complex anatomy of the fistula, we managed it surgically rather than percutaneously. There were no complications early after surgery and at 1 year’s follow-up.

1. Pompa JJ, Kinlay S, Bhatt DL. Coronary arteriography and intracoronary imaging. In: Bonow RO, Mann DL, Zipes DP, Libby P, Braunwald E, eds. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia: Saunders; 2015. p. 392-424
2. Gowda RM, Vasavada BC, Khan IA. Coronary artery fistulas: clinical and therapeutic considerations. Int J Cardiol 2006;107:7-10.
3. Zenooz NA, Habibi R, Mammen L, Finn JP, Gilkeson RC. Coronary artery fistulas: CT findings. Radiographics 2009;29:781–789
4. Lim JJ, Jung JI, Lee BY, Lee HG. Prevalence and types of coronary artery fistulas detected with coronary CT angiography. AJR Am J Roentgenol 2014;203:W237-243.
5. Greenberg MA, Fish BG, Spindola-Franco H. Congenital anomalies of coronary artery: classification and significance. Radiol Clin North Am 1989;27:1127–1146.
6. Challoumas D, Pericleous A, Dimitrakaki IA, Danelatos C, Dimitrakakis G. Coronary arteriovenous fistulae: a review. Int J Angiol 2014;23:1–10.
7. Ibrahim MF, Sayed S, Elasfar A, Sallam A, Fadl M, Al Baradai A. Coronary fistula between the left anterior descending coronary artery and the pulmonary artery: two case reports. J Saudi Heart Assoc 2012;24:253–256.
8. Pouraliakbar HR, Sadeghpour A, Alizadehasl A, Firoozi A, Homightoun K, Alborzi N, Bayati P, Movassaghi M. Large coronary-cameral fistulas in an adult patient: a rare coronary anomaly with concealed clinical findings (case report and literature review). Arch Cardiovasc Imaging 2016;4:1-7.
9. Sağlam H, Koçoğullari CU, Kaya E, Emmiler M. Congenital coronary artery fistula as a cause of angina pectoris. Turk Kardiyol Dern Ars. 2008;36:552-554. PMID: 19223723.
10. Awasthy N, Radhakrishnan S. Stepwise evaluation of left to right shunts by echocardiography. Indian Heart J 2013;65:201–218.
11. Holzer R, Johnson R, Ciotti G, Pozzi M, Kitchiner D. Review of an institutional experience of coronary arterial fistulas in childhood set in context of review of the literature. Cardiol Young 2004;14:380–385.
12. Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM, Crumb SR, Dearani JA, Fuller S, Gurvitz M, Khairy P, Landzberg MJ, Saidi A, Valente AM, Van Hare GF . ACC/AHA 2008 Guidelines for the management of adults with congenital heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to develop guidelines for the management of adults with congenital heart disease). Circulation 2008;118:2395–2451.
13. Mangukia C. Coronary Artery Fistula. Ann Thorac Surg 2012;93:2984-2092.
14. Schumacher G, Roithmaier A, Lorenz HP, Meisner H, Sauer U, Müller KD, Sebening F, Bühlmeyer K. Congenital coronary artery fistula in infancy and childhood: diagnostic and therapeutic aspects. Thorac cardiovasc Surg 1997;45:287-294.
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IssueVol 15 No 4 (2020): J Teh Univ Heart Ctr QRcode
SectionCase Report(s)
Published2020-10-31
DOI https://doi.org/10.18502/jthc.v15i4.5946
Keywords
Heart Defects; Congenital Fistula Computed tomography angiography

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Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Peighambari M, Pakbaz M, Alizadehasl A, Hosseini S, Pouraliakbar H. A Case of Coronary Cameral Fistula: When and How to Intervene?. J Tehran Heart Cent. 15(4):189-194.