Long-Term Follow-Up of a Nonprogressive Left Main Coronary Artery Fistula to Right Atrium.

Coronary artery fistula is a rare cardiac abnormality, occurring more frequently in young patients and treated with cardiac surgery or percutaneous interventions in most cases. We present the case of a 63-year-old man with an incidental diagnosis of coronary artery fistula, treated with conservative strategy. (Level of Difficulty: Intermediate.).

Coronary artery fistulas as a rare cause of heart failure and ventricular arrhythmia, associated with multiple large vessel fistulas.

Coronary artery fistulas are abnormal connections between the coronary arteries with a heart chamber or any of the major blood vessels. Fistulous connections between systemic arteries and pulmonary vessels are even less frequent. We present a case of a 71-year-old man with symptoms of dyspnea, exercise intolerance, and ventricular arrhythmia who attended the emergency department. Coronary angiography revealed bilateral coronary fistulas drained into the pulmonary circulation. Computed tomography angiography revealed the presence of fistulas arising from the descending aorta, right internal mammary artery, and subclavian arteries, all these drained into the pulmonary circulation. Due to the rarity of the disease, there are no international guidelines for the management of coronary fistulas and the treatment is controversial. Coronary artery fistula is a rare pathology that should be included in the differential diagnosis of heart failure and ventricular arrhythmia.

Indispensable Role of Multimodality Imaging in Diagnosis and Management of Coronary Arteriovenous Fistulas.

We describe a patient with right coronary artery to coronary sinus fistula requiring surgical elimination. The decision process in managing fistulas depends on the size, site of origin, and symptoms caused by the fistula. We highlight the pivotal role of multimodality cardiovascular imaging in the diagnosis and management of coronary fistulas. (Level of Difficulty: Intermediate.).

Transcatheter Occlusion of Coronary-Pulmonary Fistula With a Liquid Embolic Agent After Evaluation by FFR.

A 58-year-old man was admitted for stable angina. The coronary angiogram revealed a coronary-pulmonary fistula with a nonsignificant atheroma. We decided to perform percutaneous embolization of the fistula in view of the symptoms and the hemodynamic assessment findings. Embolization was performed using a liquid embolic agent with no residual flow. (Level of Difficulty: Intermediate.).

Percutaneous Coil Embolization of Coronary Artery Fistula Complicated by Refractory Ventricular Fibrillation and Cardiogenic Shock.

We present a case of a 56-year-old patient with a symptomatic right coronary artery to pulmonary artery fistula who underwent coil embolization. Post-procedure, the patient developed ventricular fibrillation that was refractory to antiarrhythmic medications and numerous attempts at defibrillation. (Level of Difficulty: Intermediate.).

Multivessel Coronary Artery Disease in a Patient With Noncompaction Cardiomyopathy With Coronary Artery-to-Left Ventricle Fistulas.

Coexistence of coronary artery-to-left ventricle fistula (CALVF) and noncompaction cardiomyopathy (NCC) is rare in patients with severe multiple coronary stenosis. We report CALVF in a 70-year-old man with acute coronary syndrome (ACS) and NCC. Left ventricular ejection fraction may not improve by total revascularization in this condition. (Level of Difficulty: Advanced.).

Transcatheter Closure of Complex Left Circumflex to Coronary Sinus Fistula.

Coronary artery fistulae connecting the left circumflex to the coronary sinus are rare. Surgical closure of coronary sinus connections is technically challenging because of the location, especially in high-risk surgical patients. We used multimodality imaging to delineate the drainage site and successfully closed a left circumflex to coronary sinus fistula using a transcatheter closure technique. (Level of Difficulty: Advanced.).

Closing a Right Coronary Artery Fistula Draining Into the Coronary Sinus Using a Covered Stent in the Coronary Sinus.

This report describes the case of a symptomatic patient with a right coronary artery fistula draining into the coronary sinus who underwent transcatheter closure, which was deployed in the drainage site to seal off the exit of the fistula. (Level of Difficulty: Advanced.).

A Continuous Murmur as the Only Clinical Sign for Complex Coronary Artery Fistulas Diagnosis.

An asymptomatic patient presented at our hospital exhibiting a Brugada electrocardiography pattern with coronary artery fistulas. Coronary artery fistula is a congenital or acquired rare abnormal condition with increased symptoms and complications over time. In the absence of the therapeutic consensus, we discuss the association and management for this condition. (Level of Difficulty: Advanced.).

A Rare Case of Coronary Artery Dilatation and Giant Pseudoaneurysm.

Coronary artery fistula are anomalous connections with coronary vessels or cardiac chambers, potentially resulting in coronary dilatation and pseudoaneurysm formation. We present the case of a 68-year-old woman referred to our institution for a voluminous coronary pseudoaneurysm secondary to coronary artery fistula presenting as a nearly completely obstructive left atrial mass. (Level of Difficulty: Intermediate.).

Unusual Case of Giant Nonthrombosed Right Coronary Artery Pseudoaneurysm With Coronary Artery Fistula.

Coronary artery aneurysm and pseudoaneurysm are rare and mainly result from atherosclerosis. We present a successfully treated case of a giant right coronary artery aneurysm and pseudoaneurysm with a coronary artery fistula, which might have developed after cardiac surgery for a right ventricular tumor 35 years earlier. (Level of Difficulty: Advanced.).

Percutaneous Coil Embolization for Symptomatic Coronary Fistula: Pre-Operative Cardiovascular Optimization Before Renal Transplantation.

Pre-operative optimization of cardiovascular conditions in patients awaiting renal transplantation significantly improves post-transplantation cardiac complications. We describe a case of symptomatic coronary fistula treated with percutaneous coil embolization in a young adult awaiting renal transplantation. (Level of Difficulty: Advanced.).

Percutaneous Coil Embolization of Confluent Bilateral Coronary Artery Fistulas.

A 52-year-old woman presented with a continuous heart murmur at an annual health examination. Coronary computed tomography angiography showed confluent coronary artery fistulas meeting to form a large aneurysm fistulizing to the pulmonary artery. Percutaneous coil embolization was performed, resulting in the disappearance of the coronary artery fistulas and aneurysms. (Level of Difficulty: Intermediate.).

Coronary Artery Fistula: An Unexpected Cause of Heart Failure in a 58-Year-Old Woman.

Coronary artery fistula (CAF) is an abnormal connection between a coronary artery and a heart chamber resulting in left-to-right shunt. A large CAF was an unexpected cause of heart failure in a 58-year-old woman who underwent transcatheter closure of the CAF with improvement in symptoms but complicated by myocardial infarction. (Level of Difficulty: Beginner.).