Recognition of left coronary artery fistula to the left and right ventricles by contrast echocardiography

A coronary-cameral fistula was inspected clinically by two-dimensional and pulsed Doppler ultrasound. At cardiac catheterization a fistulous connection between the left coronary artery and the right ventricle was observed. Contrast echocardiography using agitated saline solution injected into the aortic catheter clearly showed the passage of microcavitations into the left and the right ventricles confirming the connection of the fistula to both chambers. Contrast echocardiography is a valuable technique that can help define the site of drainage of coronary artery fistulas.     

False aneurysm of the ascending aorta with perforation into the right ventricle presenting as acute inferior myocardial infarction

The authors describe the case of a 76-year-old woman who presented with acute inferior myocardial infarction 8 years after prosthetic aortic valve replacement. Echocardiography and cardiac catheterization revealed a false aneurysm of the ascending aorta with fistulous communication to the right ventricle. The right coronary artery originated from the false aneurysm with no antegrade perfusion.     

Giant aneurysm of a saphenous vein graft with fistulization into the right atrium: differential diagnosis and treatment]

The aneurysm of an aortocoronary saphenous vein graft is a rare but potentially fatal complication of coronary artery bypass grafting. This case came to our observation after a single episode of hypotension, followed by dyspnea in a man previously operated on for coronary artery bypass grafting. A para-hilar mass was found on routine roentgenogram. The spiral computed tomographic scan was suggestive for aortic pseudoaneurysm. The correct diagnosis was obtained by cardiac catheterization showing a giant graft aneurysm determining compression and fistulous communication into the right atrium. The difficult diagnosis and the surgical treatment are discussed.     

Unusual form of coronary artery fistula of left anterior descending and right coronary artery in an adult patient

An unusual morphologically tortuous, common fistulous communication of the left anterior descending and right coronary artery with the right ventricle was found in a 55-year-old male patient with severe aortic and mild mitral regurgitation. The angiographic features of this lesion are discussed because of the rarity of this doubly rare coronary artery fistula.     

Native vessel angioplasty as treatment strategy for left internal mammary artery to pulmonary vasculature fistula producing coronary steal phenomenon

Formation of fistulous connection between internal mammary graft and pulmonary vasculature after coronary artery bypass graft (CABG) is a rare event, which can result in recurrence of symptoms ranging from stable angina to myocardial infarction related to coronary steal. We hereby report a case of a 56-year-old man who was detected to have such a fistulous communication leading to coronary steal as the cause of effort angina 3 years after CABG. Coronary angioplasty and stenting of left anterior descending artery resulted in resolution of symptoms. Native vessel percutaneous coronary intervention as a treatment strategy for internal mammary artery to pulmonary artery fistula has not been reported previously.     

Right coronary artery cirsoid with fistulous connection to the coronary sinus

A 61-yr-old woman was referred to our hospital for evaluation of a suspected right atrial myxoma. The transesophageal echocardiogram suggested the presence of an anomalous right coronary artery with fistulous connection to the coronary sinus. At cardiac catheterization, an oxygen stepup in the right atrium indicated a 1.3:1.0 left-to-right shunt. Aortic root angiography showed a large and calcified right coronary artery cirsoid draining to the coronary sinus, which appeared remarkably dilated. In this rare anomaly, cardiac catheterization is necessary, not only to quantify the magnitude of the left-to-right shunt, which is an important requirement for the indication to surgical treatment, but also to confirm the echocardiographic diagnosis.© 1993 Wlley-Liss, Inc     

Fistulous Connection of a Greatly Dilated Tortuous Right Coronary Artery to the Coronary Sinus

Congenital coronary artery fistulas (CAFs) constitute an unusual cardiovascular anomaly. The aneurysmal appearance of CAFs is not uncommon and depends on the shunt size. However, few cases of ectatic coronary arteries (type III according to Markis et al. classification-diffuse ectasia in one vessel) supplying the fistulas have been reported. Below, we report the case of a 65-year-old woman, who referred to our department because of worsening exertional dyspnea. Echocardiographic evaluation, both transthoracic and transesophageal, performed after admission disclosed a giant tortuous ectatic right coronary artery with a fistulous connection to the coronary sinus. The presence of the CAF was confirmed by cardiac catheterization. In addition, we discuss the pathophysiology of the above congenital anomaly, as well as its management.     

Coronary artery bypass graft pseudoaneurysm communicating with the right atrium: A case report and review

We report a pseudoaneurysm of the right coronary artery bypass graft with fistulous drainage into the right atrium. This patient presented with an acute myocardial infarction in a different vascular territory. Cardiac catheterization led to the diagnosis of the pseudoaneurysm. A review of pseudoaneurysms of aortocoronary bypass grafts is presented. © 1996 Wiley-Liss, Inc.     

Mid left anterior descending coronary artery originating from the right coronary artery

Dual connection of the left anterior descending coronary artery to the left and right coronary arteries is a very rare congenital anomaly. In this report we describe two cases in which the mid-position of the left anterior descending coronary artery is connected to the right coronary artery, one directly and the second by way of the infundibular artery. To the best of our knowledge, connection of the mid-position of the left anterior descending to the infundibular artery has not been previously described.     

Rupture of aneurysmal circumflex coronary artery into the left atrium after ligation of its arteriovenous fistula.

Aneurysmal circumflex coronary artery (Cx) with fistulous connection to the coronary sinus is a rare clinical entity that usually remains asymptomatic until later in life, so the ideal therapeutic strategy is poorly defined. The timing of surgical treatment for asymptomatic patients is a big issue, and whether to leave or exclude the diffuse aneurysm in addition to ligation of the fistula is controversial, considering the native myocardial circulation. Complete surgical repair, including exclusion of a diffusely aneurysmal Cx and coronary revascularization to a graftable branch in the circumflex area combined with ligation of its fistula, is quite challenging and sometimes fatal because of a broad posterolateral myocardial infarction without revascularization caused by a lack of graftable branches. A case of diffuse aneurysmal Cx, which ruptured into the left atrium after surgical ligation of its fistulous connection to the coronary sinus, is presented. Simple ligation of the fistula, leaving a gigantic aneurysmal circumflex artery, is hazardous for later rupture and should be avoided. Therapeutic strategies for this complex disorder are discussed, including the optimal timing of surgical treatment.     

Aberrant right subclavian artery-esophageal fistula and severe gastrointestinal bleeding after surgical correction of scimitar syndrome

Scimitar syndrome and gastrointestinal bleeding from an aberrant right subclavian artery-esophageal fistula are each extremely rare. Although scimitar syndrome and aberrant right subclavian artery are typically asymptomatic in adults, fistulous connection between the aberrant artery and the esophagus is associated with a poor prognosis. Outcomes are contingent upon timely diagnosis and prompt surgical repair. Prolonged nasogastric and endotracheal intubation can lead to gastrointestinal bleeding in patients who have an aberrant right subclavian artery or other vascular ring. We recommend neither embolization nor the use of endovascular stents as anything other than a temporizing measure in the management of aberrant right subclavian artery injury. These methods can stop acute hemorrhage; however, sentinel bleeding will eventually occur and require definitive ligation.We report the case of a 57-year-old woman in whom an aberrant right subclavian artery-esophageal fistula developed after surgical correction of symptomatic scimitar syndrome. Massive gastrointestinal bleeding resulted from prolonged nasogastric and endotracheal intubation. To our knowledge, this is the first report of aberrant right subclavian artery and scimitar syndrome in the same patient, and the 4th report of a patient's surviving a fistula between the aberrant artery and the esophagus.     

Vascular aneurysm producing divided right atrium in a patient with pulmonary atresia and intact ventricular septum

We describe a patient with pulmonary atresia and intact ventricular septum in whom the right atrium was divided by a vascular aneurysm located in the right atrioventricular groove. We postulate that the structure represents an aneursymally dilated right coronary artery taking anomalous origin from the pulmonary trunk, with fistulous communication to the right atrium. We discuss the findings relative to concepts of development of the coronary arteries in normal hearts and in pulmonary atresia with an intact ventricular septum.     

Anomalous origin of single coronary artery in association with pulmonary atresia

We report a case of pulmonary atresia with intact septum associated with single coronary artery which originated from the pulmonary trunk. The combination of stenotic pulmonary trunk with presence of right ventricular to coronary artery fistulous connections probably impaired myocardial perfusion after birth.     

Coronary artery fistula from the left circumflex to the coronary sinus

A 27-year-old woman, who had received mitral valve repair for mitral regurgitation resulting from infective endocarditis, was admitted for a close examination of abnormal echocardiographic findings in the left atrium. Transthoracic echocardiography showed trivial mitral regurgitation with normal left ventricular contraction and dilatation of the coronary sinus. Auscultation revealed a grade 2 continuous murmur along the left sternal border. Transesophageal echocardiography demonstrated a marked dilatation of the coronary sinus just behind the posterior wall of the left atrium and turbulent blood flow in the dilated coronary sinus. Cardiac catheterization showed no significant step-up of oxygen saturation in the right heart and normal pulmonary artery pressure. Coronary angiography revealed a markedly dilated and tortuous circumflex coronary artery connected to the coronary sinus through a fistula. A left circumflex artery with a fistulous connection to the coronary sinus is extremely rare.     

Penetrating injury of the chest and coronary arteriovenous fistula.

An unusual case of coronary artery fistula, due to a stab wound in the chest in a 17-year-old male patient, with a resultant acute inferior myocardial infarction is presented. At surgery, complete transection of the right coronary artery was found, which formed a fistulous communication with both the right atrium and the right ventricle. The development of a continuous murmur in the period immediately after the injury, the absence of hemopericardium, and multiple cardiac-chamber involvements were unique features of the case. The inferior myocardial wall was akinetic due to infarction and did not improve following revascularization surgery. A brief review of the literature is also presented.     

Congenital Circumflex Artery-coronary Sinus Fistula in an Adult Female Associated with Severe Mitral Regurgitation and Myelodysplasy—Case Report and Review of the Literature

Background. Coronary artery fistulas are uncommon anomalies. They occur in 0.1–0.2% of patients undergoing coronary arteriography. The origin of the fistulas is the right coronary artery followed by the left anterior descending and lastly by the circumflex artery (17%). Termination into the right heart side occurs in 90% of cases. Termination into the coronary sinus is rare in 3% of cases. Circumflex artery–coronary sinus fistulas are even rarer. Design. A single case report and literature review between 1993 and 2007. Results. We describe a 76-year-old female, who was analyzed for dyspnea on exertion (DOE) and chronic fatigue, with known myelodysplastic syndrome and an aneurysmal circumflex coronary artery–coronary sinus fistulous connection associated with severe mitral regurgitation. Mitral valve replacement using a bioprosthesis was performed as well as ligation of the fistula. The postoperative course was complicated with cardiac tamponade, which was successfully drained. Conclusion. Our patient presented with chronic fatigue and DOE and was found to have a coronary artery fistula and severe mitral regurgitation associated with known myelodysplasia. Conventional coronary angiography failed to demonstrate the entire fistula characteristics (origin, pathway, and outflow). Multidetector computed tomography was complementary to demonstrate the complex anatomy of the fistula. The fistula was surgically ligated in combination with mitral valve replacement. She remains well.     

A large coronary artery saphenous vein bypass graft aneurysm with a fistula: case report and review of the literature.

We describe a patient who developed a large aneurysm of saphenous vein graft to the right coronary artery with a fistulous communication to the right atrium. The presence of a fistulous communication of a saphenous vein graft aneurysm after coronary bypass surgery to one of the heart chambers is extremely rare. The diagnosis was made by coronary angiography and confirmed by CT and MRI. At surgery the aneurysm was ligated and excised. The fistula to the right atrium was closed. Repeat coronary artery bypass surgery with aortic valve replacement was performed at the same time without complications. Cathet. Cardiovasc. Intervent. 48:214-216, 1999.     

Coronary Artery Fistulas: A Review of the Literature and Presentation of Two Cases of Coronary Fistulas with Drainage into the Left Atrium

We report 2 cases of infants presenting with a murmur shortly after birth and diagnosed with coronary artery fistulas with drainage into the left atrium. The first infant had a fistulous communication between the left main coronary artery and the left atrial appendage and presented with signs and symptoms of heart failure. The infant was repaired surgically in the first week of life. The second infant was asymptomatic and had a fistulous communication between the right coronary artery and the left atrium. The infant will have the fistula closed in the cardiac catheterization laboratory when the child is older. The literature on coronary artery fistulas is reviewed, and the diagnosis and management of coronary artery fistulas is discussed.     

A unique double right coronary artery abnormality

Double right coronary artery is a very rare coronary artery abnormality. Two cases have been reported so far. In these cases, both right coronary arteries were giving the same branches, and originated from the same orifice. In our case, both right coronary arteries were giving different branches. We could not find such a case in the literature. Therefore, we consider our case a unique double right coronary artery abnormality.     

Large spontaneous coronary artery-to-right ventricular fistula

We report a case of the spontaneous formation of a left anterior descending artery to right ventricular fistula. The unprovoked appearance of this fistulous connection was clearly documented by serial angiography and confirmed during surgery.