Korean Circ J.  2008 Jun;38(6):331-334. 10.4070/kcj.2008.38.6.331.

A Case of Bilateral Coronary to Pulmonary Artery Fistulas Associated With Severe Aortic Regurgitation

• Lee SJ
• Her SH
• Jin SW
• Lee JM
• Yoon HJ
• Lee HY
• Kim HY
• Kim GM
• Park CH

• KMID: 2225781
• DOI: http://doi.org/10.4070/kcj.2008.38.6.331

Abstract

Coronary artery fistula (CAF) is a rare form of congenital anomalies of the coronary arteries, and this is usually discovered by chance during coronary angiography. However, this type of fistula can cause important coronary morbidity and mortality leading to angina, syncope, congestive heart failure, myocardial infarction and sudden death. Bilateral CAFs are even rarer, and especially when combined with valvular heart disease. The coincidence of CAF with aortic regurgitation is relatively rare and this might sometimes cause myocardial ischemia. We present here a case of bilateral coronary-pulmonary artery fistulas that arose from the first diagonal branch of the left anterior descending artery and the conal branch of the right coronary artery combined with severe aortic regurgitation, and this all caused myocardial ischemia.

Keyword

Arteriovenous fistula; Coronary vessels; Aortic regurgitation

MeSH Terms

Aortic Valve Insufficiency
Arteries
Arteriovenous Fistula
Coronary Angiography
Coronary Vessels
Death, Sudden
Fistula
Heart Failure
Heart Valve Diseases
Myocardial Infarction
Myocardial Ischemia
Pulmonary Artery
Syncope

Figure

• 

  Fig. 1 The aortic valve revealed by the color flow and 2-dimensional echocardiogram of the TEE. TEE shows severe aortic regurgigation (A) and incapacitated cusps (white arrow) of the aortic valve during the diastolic phase (B). TEE: transesophageal echocardiography.

• 

  Fig. 2 The left coronary angiogram and right coronary angiogram revealed by the 6 Fr Judkins catheter. Coronary angiography shows that the bilateral coronary pulmonary artery fistulas arise from the first diagonal branch of the left anterior descending artery (A) and the conal branch of the right coronary artery (B).

• 

  Fig. 3 The aortogram revealed by the pig-tail catheter. The aortogram showed that aortic regurgitant flow reached to the left ventricular apex via backflow (white arrow) of the aortic valve during the diastolic phase (A), but any backflow was not visualized in the left ventricle during the systolic phase (B).

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