J Lipid Atheroscler.  2015 Jun;4(1):35-38. 10.12997/jla.2015.4.1.35.

Complex Coronary Artery Fistula Causing Angina is Resolved Through Coil Embolization

• Lee HJ
• Kang SH
• Koo BK
• Lee HY

• KMID: 2005733
• DOI: http://doi.org/10.12997/jla.2015.4.1.35

Abstract

Coronary artery fistulas (CAFs) are rare, mostly congenital cardiac anomalies. Most are asymptomatic and do not require treatment, but some can cause angina or exertional dyspnea. Symptomatic or hemodynamically significant fistulae can be treated with transcatheter or surgical methods of closure, with the former being a less invasive alternative while showing similar effectiveness and morbidity. We present a 52-year-old man with a complex coronary artery to pulmonary artery fistula causing angina, successfully treated by transcatheter coil embolization. Even without complete closure, this patient showed improvement of symptoms and objective indices of myocardial ischemia.

Keyword

Coronary artery fistula; Coronary artery to pulmonary artery fistula; Transcatheter coil embolization

MeSH Terms

Coronary Vessels*
Dyspnea
Embolization, Therapeutic*
Fistula*
Humans
Middle Aged
Myocardial Ischemia
Pulmonary Artery

Figure

• 

  Fig. 1 Coronary CT angiography shows fistulae originating from (A) the proximal right coronary artery (RCA), (B) left main coronary artery (LMCA), and ascending aorta near the LMCA. The fistulae drain into the left side of the main pulmonary trunk.

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  Fig. 2 Coronary angiography shows (A) the right coronary-to-pulmonary artery fistula, (B) Selective embolization with coiling was performed.

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  Fig. 3 (A) Pre-procedural treadmill test (TMT) shows ST depression at leads II, III, aVF, V4, V5 (black arrows), suggesting myocardial ischemia, (B) TMT six months later shows no signs of myocardial ischemia.

Reference

1. Dodge-Khatami A, Mavroudis C, Backer CL. Congenital heart surgery nomenclature and database project: anomalies of the coronary arteries. Ann Thorac Surg. 2000; 69:S270–S297.

2. Mangukia CV. Coronary artery fistula. Ann Thorac Surg. 2012; 93:2084–2092.

3. Fernandes ED, Kadivar H, Hallman GL, Reul GJ, Ott DA, Cooley DA. Congenital malformations of the coronary arteries: the Texas Heart Institute experience. Ann Thorac Surg. 1992; 54:732–740.

4. Ata Y, Turk T, Bicer M, Yalcin M, Ata F, Yavuz S. Coronary arteriovenous fistulas in the adults: natural history and management strategies. J Cardiothorac Surg. 2009; 4:62.

5. Armsby LR, Keane JF, Sherwood MC, Forbess JM, Perry SB, Lock JE. Management of coronary artery fistulae. Patient selection and results of transcatheter closure. J Am Coll Cardiol. 2002; 39:1026–1032.

6. Onorati F, Mastroroberto P, Bilotta M, Cristodoro L, Esposito A, Pezzo F, et al. Surgical treatment of coronary-to-pulmonary fistula: how and when? Heart Vessels. 2006; 21:321–324.

7. Taleb MM, Sheikh MA, Cooper CJ, Tinkel JL. Multiple coronary to pulmonary artery fistulas: a case report and review of the literature. Cardiovasc Interv Ther. 2012; 27:127–130.