RESUMEN
BACKGROUND: A coronary artery fistula is an abnormal connection between one or more coronary arteries and a cardiac chamber or great vessel, often discovered incidentally through cardiac imaging. Although coronary artery fistulas are typically asymptomatic during the first two decades of life, particularly when small, they can become clinically significant over time. CASE PRESENTATION: We present the case of a 71-year-old female patient with a history of exertional dyspnea. Diagnostic coronary angiography revealed a significant coronary artery fistula originating from the proximal right coronary artery and draining into the pulmonary artery trunk. Given the patient's symptoms and the anatomical features of the fistula, she was successfully treated with transcutaneous closure using a liquid embolic agent (Onyx). CONCLUSION: Although surgical intervention has historically been the primary treatment for CAF, minimally invasive techniques such as transcutaneous closure are proving to be effective alternatives.
Asunto(s)
Fístula Arterio-Arterial , Arteria Pulmonar , Humanos , Femenino , Anciano , Fístula Arterio-Arterial/cirugía , Fístula Arterio-Arterial/diagnóstico por imagen , Arteria Pulmonar/anomalías , Arteria Pulmonar/diagnóstico por imagen , Arteria Pulmonar/cirugía , Angiografía Coronaria , Embolización Terapéutica/métodosRESUMEN
A 60-year-old man with hypercholesterolemia and hypertension presented with acute coronary syndrome (SCA). The ECG showed lateral ischemia (T-wave inversion in V4-V6, D1 and aVL) and echocardiography showed normal left ventricular wall motion. Coronary angiography showed critical atherosclerotic lesions in the distal part of the left circumflex artery (LCx, culprit lesion), chronic total occlusion of the right coronary artery (RCA), significant but not critical stenosis in the middle part of left anterior descending artery (LAD), and a coronary artery to pulmonary artery (PA) fistula originating from the proximal part of the LAD and emptying into the PA via a coronary saccular aneurysm (12 x 12 x 10 mm). A multidetector row computed tomography angiography (CTA) confirmed the coronary artery fistula, which was treated with surgical approach. The patient underwent aneurysmorrhaphy with CAF closure and coronary artery bypass grafting on the RCA and LCx. The postoperative course was uneventful and the patient was discharged on postoperative day 14. CTA was useful for understanding the spatial relation of the CAF and the connection with the PA.
Asunto(s)
Fístula Arterio-Arterial , Aneurisma Coronario , Arteria Pulmonar , Humanos , Masculino , Arteria Pulmonar/cirugía , Arteria Pulmonar/diagnóstico por imagen , Persona de Mediana Edad , Fístula Arterio-Arterial/cirugía , Fístula Arterio-Arterial/complicaciones , Aneurisma Coronario/cirugía , Aneurisma Coronario/complicaciones , Aneurisma Coronario/diagnóstico por imagen , Puente de Arteria Coronaria/métodos , Angiografía CoronariaAsunto(s)
Fístula Arterio-Arterial , Arteria Pulmonar , Humanos , Arteria Pulmonar/diagnóstico por imagen , Arteria Pulmonar/anomalías , Fístula Arterio-Arterial/diagnóstico por imagen , Masculino , Angiografía por Tomografía Computarizada/métodos , Angiografía Coronaria/métodos , Anomalías de los Vasos Coronarios/diagnóstico por imagen , Femenino , Persona de Mediana EdadAsunto(s)
Fístula Arterio-Arterial , Arteria Pulmonar , Humanos , Arteria Pulmonar/diagnóstico por imagen , Arteria Pulmonar/cirugía , Fístula Arterio-Arterial/diagnóstico por imagen , Fístula Arterio-Arterial/cirugía , Masculino , Aneurisma de la Aorta Torácica/cirugía , Complicaciones Posoperatorias/etiología , Persona de Mediana Edad , Aneurisma de la Aorta/diagnóstico por imagen , Aneurisma de la Aorta/cirugíaRESUMEN
We present a 67-year-old male with past medical history of hyperlipidemia, hypertension, and emphysema, and who was a former smoker, with dyspnea on exertion and chest pain.
Asunto(s)
Arterias Bronquiales , Bronquiectasia , Enfermedad de la Arteria Coronaria , Humanos , Masculino , Anciano , Enfermedad de la Arteria Coronaria/diagnóstico , Enfermedad de la Arteria Coronaria/complicaciones , Bronquiectasia/diagnóstico , Bronquiectasia/complicaciones , Bronquiectasia/etiología , Angiografía Coronaria/métodos , Enfermedad Crónica , Vasos Coronarios/diagnóstico por imagen , Fístula Arterio-Arterial/diagnóstico , Fístula Arterio-Arterial/complicaciones , Anomalías de los Vasos Coronarios/diagnóstico , Anomalías de los Vasos Coronarios/complicacionesRESUMEN
This case demonstrated intraoperative real-time transesophageal echocardiographic monitoring in minimally invasive small-incision Off-pump ligation of a coronary artery fistula,demonstrating the importance of esophageal echocardiography in surgical monitoring.
Asunto(s)
Fístula Arterio-Arterial , Enfermedad de la Arteria Coronaria , Humanos , Ecocardiografía Transesofágica , Fístula Arterio-Arterial/diagnóstico por imagen , Fístula Arterio-Arterial/cirugía , Arteria Pulmonar/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/cirugíaRESUMEN
BACKGROUND: The proportion of abnormal electrocardiogra (ECG) in patients with coronary artery fistula (CAF) is relatively high, but the correlation between CAF and arrhythmia is mostly reported in individual case studies. This paper analyzes the correlation between imaging features and ECG features. OBJECTIVE: This paper aims to analyze the incidence and distribution characteristics of abnormal ECG in patients with CAF and further explore the difference in ECG characteristics between coronary-cameral fistula (CCF) and coronary-pulmonary artery fistula (CPAF). METHOD: A total of 144,448 patients who underwent coronary computerized tomography angiography (CTA) examination from January 2016 to December 2022 were included in this study, and 284 patients with CAF (excluding coronary atherosclerosis) were selected for analysis of their ECG and image characteristics. And divided them into the CPAF (221 cases) and CCF (63 cases) groups, the differences in ECG between the two groups was compared. The changes in the ECG after the operation were analyzed. RESULTS: The incidence of abnormal ECG in patients with CAF was approximately 72.9%. There were significant differences in the proportion of ECG block, myocardial ischemia and structural ECG changes between the CPAF group and CCF group (P < 0.05). CCF was more likely to cause conduction block and ischemic and structural ECG changes. A total of 53 patients with CAF underwent surgical treatment, 28 patients with improved ECG (52%). CONCLUSION: CCF especially CCF patients often have abnormal ECG findings such as conduction block, myocardial ischemia, and structural changes, which can often be restored to normal through surgery.
Asunto(s)
Fístula Arterio-Arterial , Enfermedad de la Arteria Coronaria , Humanos , Angiografía Coronaria/métodos , Fístula Arterio-Arterial/diagnóstico por imagen , Fístula Arterio-Arterial/epidemiología , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/epidemiología , ElectrocardiografíaAsunto(s)
Fístula Arterio-Arterial , Arterias Bronquiales , Arteria Pulmonar , Femenino , Humanos , Fístula Arterio-Arterial/diagnóstico por imagen , Fístula Arterio-Arterial/cirugía , Arterias Bronquiales/diagnóstico por imagen , Arterias Bronquiales/anomalías , Angiografía por Tomografía Computarizada/métodos , Arteria Pulmonar/anomalías , Arteria Pulmonar/diagnóstico por imagen , Enfermedades Raras , Tomografía Computarizada por Rayos X/métodos , AncianoRESUMEN
Coronary artery fistula is a rare abnormality in the communication between a coronary artery and any of the cardiac chambers or major vessels. At present, there is no standard surgical treatment and the most appropriate method is selected on a case-by-case basis. We report one case of coronary artery fistulae in which pulmonary artery transection was required around the left main trunk (LMT). A 62-year-old man who had coronary artery fistulae with an aneurysm which increased from 12 mm to 16 mm in a two-year span. The fistula was located adjacent to the LMT. A complete aneurysm excision under cardiopulmonary bypass was performed, which required pulmonary artery transection. No postoperative complications occurred. Postoperative coronary computed tomography scan showed intact coronary arteries and complete aneurysm removal.
Asunto(s)
Fístula Arterio-Arterial , Aneurisma Coronario , Enfermedad de la Arteria Coronaria , Masculino , Humanos , Persona de Mediana Edad , Aneurisma Coronario/complicaciones , Arteria Pulmonar/diagnóstico por imagen , Arteria Pulmonar/cirugía , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/cirugía , Fístula Arterio-Arterial/diagnóstico por imagen , Fístula Arterio-Arterial/cirugía , Fístula Arterio-Arterial/complicaciones , Enfermedad de la Arteria Coronaria/cirugía , Angiografía CoronariaRESUMEN
Coronary artery fistula is an uncommon congenital anomaly of the coronary arteries, and there are lots of variations. We present a-46-year-old male patient with abnormal cardiac silhouette on chest X-ray. Coronary computed tomography (CT) angiography showed coronary artery (left anterior descending artery)-to-pulmonary artery fistula with a giant aneurysm( 55 mm). Considering the risk of rupture, surgery was indicated. The patient underwent surgical repair through median sternotomy under cardiopulmorary bypass and cardiac arrest antegrade myocardial protection. Fistulas were dissected and ligated proximally and distally, then the aneuysm was resected. By flushing bloody cardioplegic solution, we confirmed that there was no residual blood inflow to the aneurysm. Post-operative course was unevenful without evidence of myocardial injury. The patient discharged home on 10th postoperative day.
Asunto(s)
Fístula Arterio-Arterial , Aneurisma Coronario , Enfermedad de la Arteria Coronaria , Fístula , Cardiopatías Congénitas , Masculino , Humanos , Aneurisma Coronario/diagnóstico por imagen , Aneurisma Coronario/cirugía , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/cirugía , Enfermedad de la Arteria Coronaria/cirugía , Arteria Pulmonar/cirugía , Angiografía Coronaria , Fístula Arterio-Arterial/diagnóstico por imagen , Fístula Arterio-Arterial/cirugíaRESUMEN
An internal mammary artery to pulmonary artery (IMA-PA) fistula is a very rare vascular abnormality. Patients with this disease are often asymptomatic, but they may develop symptoms such as heart failure and hemoptysis. A 60-year-old woman was incidentally diagnosed with left IMA-PA fistula by chest computed tomography (CT) during an examination for colon cancer. She was asymptomatic, but we determined that surgery was indicated because of the presence of an aneurysmal change. We performed complete surgical resection of the IMA-PA fistula and aneurysm under cardiopulmonary bypass. Her postoperative course was uneventful. Although a specific management strategy for IMA-PA fistula has not yet been established, surgical treatment should be performed to prevent rupture in cases with aneurysmal change.
Asunto(s)
Fístula Arterio-Arterial , Aneurisma Coronario , Fístula , Arterias Mamarias , Humanos , Femenino , Persona de Mediana Edad , Arteria Pulmonar/diagnóstico por imagen , Arteria Pulmonar/cirugía , Arteria Pulmonar/anomalías , Arterias Mamarias/diagnóstico por imagen , Arterias Mamarias/cirugía , Aneurisma Coronario/complicaciones , Fístula/cirugía , Tomografía Computarizada por Rayos X , Fístula Arterio-Arterial/diagnóstico por imagen , Fístula Arterio-Arterial/cirugía , Fístula Arterio-Arterial/etiologíaAsunto(s)
Fístula Arterio-Arterial , Aneurisma Coronario , Fístula , Humanos , Aneurisma Coronario/complicaciones , Aneurisma Coronario/diagnóstico , Aneurisma Coronario/cirugía , Corazón , Arterias , Arteria Pulmonar/diagnóstico por imagen , Fístula Arterio-Arterial/diagnóstico , Fístula Arterio-Arterial/diagnóstico por imagen , Vasos Coronarios , Angiografía CoronariaRESUMEN
A 78-year-old woman with a history of hypertension, hyperlipidemia, and asthma was referred to her cardiologist for chest pain and dyspnea on exertion. After performing stress echocardiography, it was determined that closure of the fistula with coils was indicated. This case highlights that coronary fistula could be an unusual entity of angina, clinically improving after the occlusion procedure.
Asunto(s)
Fístula Arterio-Arterial , Enfermedad de la Arteria Coronaria , Anomalías de los Vasos Coronarios , Fístula , Anciano , Angina de Pecho/diagnóstico , Angina de Pecho/etiología , Animales , Fístula Arterio-Arterial/complicaciones , Fístula Arterio-Arterial/diagnóstico , Fístula Arterio-Arterial/cirugía , Angiografía Coronaria , Elapidae , Femenino , Humanos , Arteria Pulmonar/diagnóstico por imagenAsunto(s)
Fístula Arterio-Arterial , Enfermedad de la Arteria Coronaria , Anomalías de los Vasos Coronarios , Fístula , Humanos , Arteria Pulmonar/diagnóstico por imagen , Arteria Pulmonar/cirugía , Anomalías de los Vasos Coronarios/complicaciones , Anomalías de los Vasos Coronarios/diagnóstico por imagen , Fístula Arterio-Arterial/diagnóstico por imagen , Angiografía CoronariaRESUMEN
OBJECTIVE: The prevalence of coronary artery fistula (CAF) based on coronary angiography has been reported. However, with the popularity of coronary computerized tomography angiography (CTA), CAFs have been found more and more by chance. The purpose of this study was to determine the prevalence and types of CAFs detected by coronary CTA, and to explore the differences in the size of fistulas, the number of complicated aneurysms, and fistulas among different types. MATERIALS AND METHODS: From January 2016 to December 2020, 96,037 patients underwent coronary CTA in our hospital. The prevalence of CAF was retrospectively evaluated, The origin, course, and drainage site of CAF and coexisting abnormalities were analysed. The conventional treatments and follow-up DSCT images were also evaluated. Analyze the difference between the coronary-pulmonary artery fistula (CPAFs) group (380) and the coronary-cameral fistula (CCF) group (99). RESULTS: Among 96,037 patients, 482 (0.5%) patients (male 232 and 250 female) had CAF. The types of CAF detected. The pulmonary artery was the most common site of drainage (380/482, 78.8%). Of the 99 CCFs, coronary to the left ventricle is the most common pattern in CCF (34/482, 7.0%). Single origins are more common in CAF (n = 361, 74.9%), multiple origins are more common in CPAFs than in CCF. There were statistically significant differences in the stoma diameter (2.4 ± 1.1 mm vs. 5.4 ± 4.3 mm p < .05), aneurysm complicated (85 cases [85/380] vs. 50 cases [50/99]), the size of aneurysm (8.8 ± 5.7 mm vs. 19.1 ± 11.6 mm, p < .05), and single fistula (261 [261/380] vs. 96 [96/99], p < .05). Most of the 380 CPAFs patients received conservative treatment (350/380, 92.1%), While the 59 CCF patients (59/93, 63.4%) were treated. CONCLUSIONS: Different from previous reports, the prevalence of CAF in coronary CTA is 0.5%, the incidence of CPAFs is the highest, and the incidence of the left ventricular fistula is higher in CCF. Compared with CPAFs, CCF fistulas were more likely to be associated with a larger diameter of draining, larger aneurysms, single fistula pattern. Coronary artery CTA is a useful and noninvasive imaging method to detect CAF, which is of great significance for the detection of small fistulas and the surgical guidance of complex CAF.