Surgical treatment of heart failure due to giant coronary artery fistula: a case report

Surgical Treatment of an Aneurysmal Coronary Artery Fistula between the Left Coronary Artery and Right Atrium: A Case Report

A coronary artery fistula (CAF) is an abnormal vascular connection between the coronary arteries and the cardiac chambers or major vessels. Although rare, CAFs can lead to substantial coronary morbidity and mortality. This study outlines the surgical management of a CAF originating from the left coronary artery and connecting to the right atrium, in a patient experiencing angina with a marked left-to-right shunt. The surgical approach involved ligation of the coronary artery and reduction of the aneurysmal portion, resulting in the patient's uneventful recovery.

Coronary Artery Fistula as Another Cause of Acute Heart Failure

Coronary artery fistulas (CAFs) are rare defects in the coronary circulation system that are usually diagnosed incidentally with cardiac imaging. Although the prognosis of coronary artery fistulas is highly variable, the complications to which they predispose patients are ultimately the determining factor. The authors describe a case of a 56-year-old male, a smoker, hospitalised for worsening dyspnoea on progressively smaller efforts, in the context of acute heart failure. During hospitalisation and imaging exams, a coronary-bronchial fistula was identified.

LEARNING POINTS

CAFs are rare and may present with different anatomical configurations and clinical syndromes.Only 17% of CAFs reported draining into the pulmonary circulation.The optimal timing and role of CAFs intervention are not clearly defined.

Coronary Artery Fistulas: Indications, Techniques, Outcomes, and Complications of Transcatheter Fistula Closure

Coronary artery fistulas (CAFs) are rare coronary anomalies that are usually diagnosed incidentally with cardiac imaging. Small CAFs are generally asymptomatic and can close over time, while some untreated medium or large CAFs can enlarge, leading to clinical sequelae such as cardiac chamber enlargement or myocardial ischemia. With the advancement of transcatheter equipment and techniques, CAFs have been increasingly closed using a percutaneous approach. However, the procedure is not free of limitations given the risk for myocardial infarction, device embolization, and fistula recanalization. In this review, the authors illustrate the contemporary procedural considerations, techniques, and outcomes of transcatheter CAF closure.

Surgical treatment of heart failure due to giant coronary artery fistula: a case report

Coronary artery fistula is a rare congenital cardiac anomaly that is often found incidentally during computed tomography angiography. Coronary fistula between the left circumflex coronary artery and the coronary sinus is among the less common forms of coronary artery fistula. A 60‐yea\r‐old female patient presented to our outpatient cardiology department with symptoms of severe, de novo heart failure. Echocardiogram revealed severe mitral regurgitation and a dilated duct that turbulently accelerated colour Doppler flow behind the left ventricle with significant left‐to‐right shunt. Cardiac magnetic resonance imaging and computed tomography angiography revealed a massively dilated fistula between the left circumflex coronary artery and the coronary sinus with a diameter of 3–4 cm. The patient underwent combined heart surgery involving mitral ring annuloplasty and fistula ligation and was discharged in stable condition on guideline‐based medical therapy. At 18 months of follow‐up, minimal residual shunt flow and mild‐to‐moderate mitral regurgitation were found. We report a rare case of congenital coronary disorder resulting in heart failure and highlight the importance of complex non‐invasive cardiac diagnostic procedures before planning and performing heart surgery.