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Tram L, Freeman P, Leusink RJ. Mediastinal mayhem: the challenges of incidental thoracic arteriovenous malformations-a case report. Eur Heart J Case Rep 2024; 8:ytae454. [PMID: 39258021 PMCID: PMC11384893 DOI: 10.1093/ehjcr/ytae454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 06/23/2024] [Accepted: 08/22/2024] [Indexed: 09/12/2024]
Abstract
Background Arteriovenous malformations (AVMs) within the mediastinum are rare vascular anomalies. With the increasing number of coronary angiographies being performed, the number of incidentally found cases is rising. This presents challenges in terms of determining the appropriate treatment strategy. Case summary We present the case of a 79-year-old man with aortic stenosis, experiencing functional dyspnoea and fatigue. Echocardiography showed a bicuspid aortic valve, and while left heart catheterization confirmed no significant coronary stenosis, it revealed a tortuous vessel originating from the circumflex artery (Cx), assumed to be heading toward the pulmonary circulation. The patient was scheduled for a surgical replacement of the aortic valve (SAVR). During the SAVR, the tortuous vessel was revealed to be a large, complex AVM located in the mediastinum. This increased both the duration of the surgery and the use of cardioplegia. Further, bleeding occurred per-operatively. Post-operatively, the patient developed tachy-brady syndrome and was treated with a pacemaker before discharge. Discussion Due to the rarity of incidental AVMs in the middle/posterior mediastinum, no standard treatment protocol is available. This leaves clinicians and surgeons to manage the disease on a case-by-case basis, often with limited experience to guide their decisions. This patient case underscores the challenge of determining whether patients should be offered transcatheter aortic valve implantation (TAVI) or surgery. Furthermore, it highlights the intricate challenges that can arise when dealing with thoracic AVMs during cardiac procedures, emphasizing the importance of pre-operative awareness and tailored surgical approaches based on multidisciplinary discussions.
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Affiliation(s)
- Louise Tram
- Department of Radiology, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Phillip Freeman
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
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2
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Kobayashi M, Kuroyanagi S, Furuya O, Matsuura M. Complete surgical repair for enlarging coronary aneurysm with coronary-pulmonary artery fistula. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivae095. [PMID: 38754123 PMCID: PMC11210059 DOI: 10.1093/icvts/ivae095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 04/15/2024] [Accepted: 05/15/2024] [Indexed: 05/18/2024]
Abstract
A 46-year-old male patient was referred to our hospital due to the presence of a coronary aneurysm showing a tendency to enlarge. Subsequent coronary angiography revealed a diagnosis of coronary aneurysm with a concomitant coronary-pulmonary artery fistula. The patient underwent a successful surgical repair, and postoperatively, experienced an uneventful recovery with no residual shunt or aneurysm.
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Affiliation(s)
- Masaaki Kobayashi
- Department of Cardiovascular Surgery, Kishiwada Tokushukai Hospital, Osaka, Japan
| | - Satoshi Kuroyanagi
- Department of Cardiovascular Surgery, Kishiwada Tokushukai Hospital, Osaka, Japan
| | - Onichi Furuya
- Department of Cardiovascular Surgery, Kishiwada Tokushukai Hospital, Osaka, Japan
| | - Makoto Matsuura
- Department of Cardiovascular Surgery, Kishiwada Tokushukai Hospital, Osaka, Japan
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3
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Takahashi T, Wakatsuki T, Ise T, Sata M. Spontaneous thrombosis of a giant aneurysm complicated with the coronary-to-pulmonary artery fistula: a case report. Eur Heart J Case Rep 2024; 8:ytae227. [PMID: 38736999 PMCID: PMC11087926 DOI: 10.1093/ehjcr/ytae227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 04/12/2024] [Accepted: 04/24/2024] [Indexed: 05/14/2024]
Abstract
Background A coronary-to-pulmonary artery fistula (CPAF) with a giant aneurysm is a rare clinical occurrence. The rupture of an aneurysm leads to a fatal outcome, thus prompting the incorporation of prophylactic measures, which have encompassed surgical resections or endovascular embolization procedures. The indications for these treatment strategies are controversial, and little has been elucidated regarding the salient characteristics underpinning the selection of a therapeutic strategy. We report a case of a giant aneurysm associated with CPAFs that was thrombosed before interventional treatment. Case summary A 43-year-old woman, who had previously undergone a right adrenalectomy for primary aldosteronism, was referred for an abnormal heart silhouette on a chest X-ray, which had not been seen three years earlier. Contrast-enhanced computed tomography and coronary angiography (CAG) revealed a giant aneurysm on the anterior aspect of the heart associated with two CPAFs. Because of the risk of rupture of the aneurysm, surgical resection was recommended; however, the patient requested endovascular therapy. On the day of intervention, CAG showed spontaneous occlusion of the feeding vessel to the aneurysm, and the aneurysm showed minimal contrast agent, suggesting spontaneous thrombosis. Because of possible recanalization of the aneurysm, coil embolization was performed, without complications. The patient remained asymptomatic, and the aneurysm was completely embolized at the one-year follow-up. Discussion The case shows that minimally invasive endovascular treatment is feasible instead of surgical resection for giant aneurysms associated with CPAFs, depending on their morphological characteristics. This perspective may offer novel insights into treatment strategies for CPAF.
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Affiliation(s)
- Tomonori Takahashi
- Department of Cardiovascular Medicine, Tokushima University Hospital, 2-50-1 Kuramoto, 770-0042 Tokushima, Japan
| | - Tetsuzo Wakatsuki
- Department of Cardiovascular Medicine, Tokushima University Hospital, 2-50-1 Kuramoto, 770-0042 Tokushima, Japan
| | - Takayuki Ise
- Department of Cardiovascular Medicine, Tokushima University Hospital, 2-50-1 Kuramoto, 770-0042 Tokushima, Japan
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Hospital, 2-50-1 Kuramoto, 770-0042 Tokushima, Japan
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4
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Ozenbas C, Sukun A. Giant Coronary-Pulmonary Artery Fistula Incidentally Detected in a Patient Presenting With Acute Inferior Myocardial Infarction. Cureus 2024; 16:e58627. [PMID: 38770477 PMCID: PMC11103546 DOI: 10.7759/cureus.58627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2024] [Indexed: 05/22/2024] Open
Abstract
Coronary artery fistulas are abnormal connections between the coronary arteries and the heart or other surrounding vascular structures. Although they are usually congenital, they can also occur iatrogenically or due to trauma. They are usually asymptomatic, but they can cause serious and even fatal complications. These complications include myocardial infarction, embolism, thrombosis, arrhythmia, and rupture. In a 54-year-old woman admitted to the emergency department with an acute inferior myocardial infarction, a giant coronary-pulmonary artery fistula was detected on angiography. The fistula could not be closed percutaneously, and computed tomography angiography (CTA) revealed extensive aneurysms and diffuse calcifications. Large fistulas should be closed due to the risk of rupture. Small fistulas should be detected by CTA, and radiologists should be familiar with the imaging features.
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Affiliation(s)
- Cemre Ozenbas
- Radiology, Tınaztepe University Private Buca Hospital, Izmir, TUR
| | - Abdullah Sukun
- Radiology, Başkent University Alanya Application and Research Center, Antalya, TUR
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5
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Yılancıoğlu RY, Turan OE, Barış MM, Özcan EE. Fluoroscopy integration module guides successful ablation in atrial fibrillation with coronary-pulmonary artery fistula. Hellenic J Cardiol 2024:S1109-9666(24)00070-8. [PMID: 38494074 DOI: 10.1016/j.hjc.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 02/24/2024] [Accepted: 03/07/2024] [Indexed: 03/19/2024] Open
Affiliation(s)
- Reşit Yiğit Yılancıoğlu
- Faculty of Medicine, Department of Cardiology Heart Rhythm Management Center, Dokuz Eylul University, Izmir 35220, Turkiye.
| | - Oğuzhan Ekrem Turan
- Faculty of Medicine, Department of Cardiology Heart Rhythm Management Center, Dokuz Eylul University, Izmir 35220, Turkiye
| | - Mahmut Mustafa Barış
- Faculty of Medicine, Department of Radiology, Dokuz Eylul University, Izmir 35220, Turkiye
| | - Emin Evren Özcan
- Faculty of Medicine, Department of Cardiology Heart Rhythm Management Center, Dokuz Eylul University, Izmir 35220, Turkiye
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6
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Zubair MH, Govinda R. Doppler Mystery: Who Could Have Done It? J Cardiothorac Vasc Anesth 2024; 38:848. [PMID: 38177048 DOI: 10.1053/j.jvca.2023.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 10/16/2023] [Indexed: 01/06/2024]
Affiliation(s)
- M Haseeb Zubair
- Department of Anesthesiology and Perioperative Medicine,Marshfield Clinic Medical Center, Marshfield, WI.
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7
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Popa RM, Ispas AF, Manea RM. A Rare Case of Left Anterior Descending Coronary Artery to Pulmonary Trunk Fistula Associated with Takotsubo Cardiomyopathy. Diagnostics (Basel) 2023; 13:2751. [PMID: 37685289 PMCID: PMC10487198 DOI: 10.3390/diagnostics13172751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 08/18/2023] [Accepted: 08/20/2023] [Indexed: 09/10/2023] Open
Abstract
Coronary-artery-to-pulmonary-artery fistulae represent rare vascular anomalies defined as abnormal communications between the coronary arteries and the pulmonary arterial system. Takotsubo Syndrome represents a stress-induced cardiomyopathy defined by transient regional systolic dysfunction of the left ventricle, with minimal elevation of cardiac biomarkers, without angiographic evidence of obstructive coronary artery disease. We hereby richly illustrate an unusual and rare case of a female patient with Takotsubo Cardiomyopathy and left-anterior-descending-coronary-artery-to-pulmonary-trunk fistula through multi-modality imaging evaluations, obtaining a detailed anatomical representation of the coronary arteries and the fistulous connection, which further guided the optimal treatment strategy. The patient was treated conservatively. The main teaching points of this case are the following: (1) The coronary fistula may represent just an incidental finding in a Takotsubo Cardiomyopathy clinical scenario. (2) The particularly rare association between left-anterior-descending-coronary-artery-to-pulmonary-trunk fistula and Takotsubo Cardiomyopathy presentation is mainly due to the stress-induced overstimulation of myocardial beta-1 receptors, accentuating the coronary steal phenomenon in the setting of the coronary fistula, manifesting as anginal pain, and also the stress-induced adrenergic drive causing the Takotsubo-like presentation with apical ballooning of the left ventricle.
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Affiliation(s)
- Ramona Mihaela Popa
- Department of Radiology and Medical Imaging, Clinical Emergency County Hospital of Brașov, 500326 Brașov, Romania
| | - Alexandru Florin Ispas
- Department of Interventional Cardiology, Clinical Emergency County Hospital of Brașov, 500326 Brașov, Romania;
| | - Rosana Mihaela Manea
- Department of Radiology and Medical Imaging, Clinical Emergency County Hospital of Brașov, 500326 Brașov, Romania
- Faculty of Medicine, “Transilvania” University of Brașov, 500019 Brașov, Romania
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8
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Xu R, Zhao G. Coronary Artery-to-Pulmonary Artery Fistula with Aneurysm Formation. Radiology 2023; 308:e223272. [PMID: 37581505 DOI: 10.1148/radiol.223272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Affiliation(s)
- Rong Xu
- From the Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, China (R.X.); Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects, Ministry of Education, Chengdu, China (R.X.); and Department of Radiology, The Fourth People's Hospital of Chengdu, No. 8 West Huli Lane, Jinniu District, Chengdu, 610041, China (G.Z.)
| | - Guocheng Zhao
- From the Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, China (R.X.); Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects, Ministry of Education, Chengdu, China (R.X.); and Department of Radiology, The Fourth People's Hospital of Chengdu, No. 8 West Huli Lane, Jinniu District, Chengdu, 610041, China (G.Z.)
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9
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Gong S, Marasco S, Wong M, Hiscock M. Left main coronary artery to pulmonary artery fistula presenting as angina and ventricular tachycardia - A case report and literature review. Clin Case Rep 2023; 11:e7231. [PMID: 37143465 PMCID: PMC10151588 DOI: 10.1002/ccr3.7231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 02/23/2023] [Accepted: 04/04/2023] [Indexed: 05/06/2023] Open
Abstract
Coronary artery fistulae are an uncommon abnormality of the coronary arteries, but when hemodynamically significant can present as angina, dyspnea, and arrhythmia as a rare cause of functional myocardial ischemia via 'coronary steal phenomenon'.
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Affiliation(s)
- Simone Gong
- Department of CardiologyEpworth Hospital RichmondMelbourneVictoriaAustralia
- Department of MedicineUniversity of MelbourneMelbourneVictoriaAustralia
| | - Silvana Marasco
- Department of CardiologyEpworth Hospital RichmondMelbourneVictoriaAustralia
- CJOB Cardiothoracic Surgery DepartmentThe Alfred HospitalMelbourneVictoriaAustralia
- Department of SurgeryMonash UniversityMelbourneVictoriaAustralia
| | - Michael Wong
- Department of CardiologyEpworth Hospital RichmondMelbourneVictoriaAustralia
| | - Martin Hiscock
- Department of CardiologyEpworth Hospital RichmondMelbourneVictoriaAustralia
- Department of MedicineUniversity of MelbourneMelbourneVictoriaAustralia
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10
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Ghumman GM, Khan A, Shafqat M, Shah J, Singh H. A Coronary Cameral Fistula Associated With Incessant Ventricular Arrhythmias. Cureus 2023; 15:e35847. [PMID: 37033551 PMCID: PMC10076682 DOI: 10.7759/cureus.35847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2023] [Indexed: 03/09/2023] Open
Abstract
Coronary cameral fistula (CCF) is a rare congenital abnormality of abnormal communication between coronary arteries and cardiac chambers. Most patients are asymptomatic, while symptomatic patients are usually present in childhood. Adult patients can present with angina, heart failure, or arrhythmias. We report a rare case of CCF with associated recurrent torsade de pointes (TdP) in the absence of ischemic heart disease and electrolyte abnormalities.
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11
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Hirofuji A, Furugen A, Kamada T, Yamazaki K, Kamiya H, Doi H. Giant Coronary Aneurysm with Coronary-Pulmonary Artery Fistula in a Jehovah's Witness. Thorac Cardiovasc Surg Rep 2023; 12:e1-e3. [PMID: 36741974 PMCID: PMC9897952 DOI: 10.1055/s-0042-1757877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 09/12/2022] [Indexed: 02/05/2023] Open
Abstract
With an incidence of 3 in 100 million, giant coronary artery aneurysm (CAA) with coronary artery fistula (CAF) is a very rare condition. To prevent rupture, giant CAA with CAF should be swiftly treated. We present a Jehovah's Witness patient with giant CAA and coronary-pulmonary artery fistula. We resected the giant CAA in one piece, while ligating the CAF, without allogeneic blood transfusion. Due to rarity of these conditions, many thoracic surgeons lack direct experience in its surgical procedures. Herein, we share footage of this surgery as an example of how to safely resect CAA with minimal bleeding.
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Affiliation(s)
- Aina Hirofuji
- Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Japan,Department of Cardiovascular Surgery, Hokkaido Cardiovascular Hospital, Sapporo, Japan,Address for correspondence Aina Hirofuji, MD Department of Cardiac Surgery, Asahikawa Medical UniversityMidorigaoka Higashi 2-1-1-1, Asahikawa 078-8510, Japan; Department of Cardiovascular Surgery, Hokkaido Cardiovascular Hospital, 1-30 South 27 West 13, Chuo-ku, Sapporo 064-8622Japan
| | - Azusa Furugen
- Department of Cardiovascular Surgery, Hokkaido Cardiovascular Hospital, Sapporo, Japan
| | - Takeshi Kamada
- Department of Cardiovascular Surgery, Hokkaido Cardiovascular Hospital, Sapporo, Japan
| | - Kenji Yamazaki
- Department of Cardiovascular Surgery, Hokkaido Cardiovascular Hospital, Sapporo, Japan
| | - Hiroyuki Kamiya
- Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Hirosato Doi
- Department of Cardiovascular Surgery, Hokkaido Cardiovascular Hospital, Sapporo, Japan
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12
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Sumitomo NF, Kodo K, Inoue T, Oyanagi T, Yamagishi H. Clinical Characteristics of Coronary-to-Pulmonary Artery Fistula in Patients with Pulmonary Atresia and Ventricular Septal Defect. J Cardiovasc Dev Dis 2023; 10:jcdd10010017. [PMID: 36661912 PMCID: PMC9867298 DOI: 10.3390/jcdd10010017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/17/2022] [Accepted: 12/31/2022] [Indexed: 01/04/2023] Open
Abstract
The existence of a coronary-to-pulmonary artery fistula (CPF) in pulmonary atresia with ventricular septal defect (PAVSD) potentially affects treatment; however, its clinical features have not been comprehensively described due to the disease's rarity. We reviewed 69 cases from 42 studies to reveal the clinical overview of patients with CPF and PAVSD. Among the included patients, the male-to-female ratio was exactly 1:1, and only two patients (3%) exhibited the 22q11.2 microdeletion syndrome. Regarding anatomical features, CPFs originated from the left coronary artery in 65% of patients, and 62% had other major aortopulmonary collateral arteries. Thirty-nine percent of patients had a definitive CPF diagnosis at 0 years of age, whereas 10% were diagnosed in adulthood. Seventy percent underwent catheter angiography to obtain a definitive CPF diagnosis. Ninety-five percent of patients underwent cardiac surgery, and among them, 43% underwent palliative surgery, whereas 52% underwent one-stage repair. Four patients including three adult patients developed cardiac dysfunction due to myocardial ischemia, and three of them exhibited improved cardiac function after the intervention for CPF. Of all the patients, 88% survived and 12% died. The surgical strategy and prognosis were similar to those in PAVSD patients without CPF. This review provides detailed clinical phenotypes that are potentially useful in enhancing the management of patients with this rare disease.
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13
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Sharifkazemi M, Mohseni-Badalabadi R, Hosseinsabet A, Hajizeinali A. Case report: Multimodal imaging diagnosis of a giant coronary artery fistula: A report of two cases. Front Cardiovasc Med 2022; 9:986078. [PMID: 36386328 PMCID: PMC9644096 DOI: 10.3389/fcvm.2022.986078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/12/2022] [Indexed: 11/29/2022] Open
Abstract
Being a very rare cardiac disease, most cases of coronary artery fistula (CAF) are genetic. Complications such as coronary steal syndrome, myocardial infarction, heart failure, or tamponade can manifest following the abnormal communication that the fistula creates between the coronary arteries and cardiac chambers or major vessels and the subsequent shunt. Most CAFs are small and asymptomatic, making diagnosis difficult. In symptomatic patients, the initial diagnostic workup is generally made with chest radiography and electrocardiography. Other imaging modalities have also been suggested to improve diagnostic accuracy. Cardiac catheterization and coronary angiography are currently the gold standard for diagnosis and planning the intervention, as they can recognize the quantum of the shunt as well as complications of a fistulous track (e.g., aneurysm formation, thrombus, leak, and the number of openings to the receiving chamber/vessel); however, this invasive method may be associated with risk. Herein, we report two patients with giant CAFs, one from the left circumflex artery to the coronary sinus and the other to the superior vena cava. Moreover, we describe how multimodal imaging, including two- and three-dimensional transesophageal echocardiography, coronary cineangiography, coronary computed tomography angiography, and enhanced chest computed tomography, can facilitate diagnosis and estimate the disease course in such patients. We believe that using multimodal imaging cannot only help the initial diagnosis regarding the presence of a CAF and the accurate anatomical site of the fistula in the patient but can also help predict the disease course and choose the most suitable treatment modality. Therefore, we suggest multimodal imaging be done to diagnose patients suspected of CAF. However, invasive cineangiography should be necessarily followed, regardless of whether an intervention is planned or not.
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Affiliation(s)
- Mohammadbagher Sharifkazemi
- Department of Cardiology, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
- *Correspondence: Mohammadbagher Sharifkazemi,
| | - Reza Mohseni-Badalabadi
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Hosseinsabet
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alimohammad Hajizeinali
- Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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14
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Torres C, Gjergjindreaj M, Torres-Ortiz H, Fuentes J, Beohar N. Coronary Steal Syndrome Secondary to Large Coronary to Pulmonary Artery Fistulas. Cureus 2022; 14:e30267. [PMID: 36381934 PMCID: PMC9650949 DOI: 10.7759/cureus.30267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2022] [Indexed: 06/16/2023] Open
Abstract
Coronary artery fistulas represent rare congenital or acquired defects in the coronary circulation. We describe a case of bilateral coronary to pulmonary artery fistulas resulting in coronary artery steal syndrome in a patient with a history of valve-sparing aortic repair surgery.
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Affiliation(s)
- Christian Torres
- Cardiology, Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami Beach, USA
| | - Medeona Gjergjindreaj
- Cardiology, Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami Beach, USA
| | - Hernando Torres-Ortiz
- Cardiology, Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami Beach, USA
| | - Jorge Fuentes
- Interventional Cardiology, Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami Beach, USA
| | - Nirat Beohar
- Interventional Cardiology, Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami Beach, USA
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Figueroa-Casanova R, Saavedra-Henao JD, Mosos-Patiño MB, Lozano-Suarez N, Beltran-Rincon DA, Perez-Rivera CJ. Coronary fistula between left anterior descendent artery and pulmonary artery: Case report with literature review. CIRUGIA CARDIOVASCULAR 2022. [DOI: 10.1016/j.circv.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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16
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Sulemankhil I, Mohamed AH, Gilani SA. Coronary-Pulmonary Artery Fistula Repair With Coil Embolization: A Single Center Experience. Cureus 2022; 14:e28407. [PMID: 36171837 PMCID: PMC9509005 DOI: 10.7759/cureus.28407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 11/17/2022] Open
Abstract
Coronary-pulmonary artery fistulas (CPF) are a rare malformation that is often asymptomatic but can be associated with dyspnea, angina, palpitation, dizziness, and syncope. Trans-catheter closure (TCC) with coil embolization is gaining prominence relative to surgical closure due to lower complications; however, there is a paucity of literature on the closure of CPFs with TCC. Here, we demonstrate a case series on the closure of a left anterior descending (LAD) artery to pulmonary artery (PA) fistula by advancing a guideliner into the coronary artery up to the origin of the coronary fistula in order to provide support for the advancement of the microcatheter and coil delivery.
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17
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Torres S, Vasconcelos M, Tavares Silva M, Moreira J, Silva JC, Macedo F. Coronary artery fistulas: A 12-year single-center experience. Rev Port Cardiol 2022; 41:843-850. [DOI: 10.1016/j.repc.2021.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/05/2021] [Accepted: 06/21/2021] [Indexed: 10/15/2022] Open
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18
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Krasniqi X, Bakalli A, Koçinaj D. Coronary to pulmonary artery fistula associated with significant coronary atherosclerosis and severe aortic valve stenosis: A Case Report. Radiol Case Rep 2022; 17:1963-1967. [PMID: 35432682 PMCID: PMC9010895 DOI: 10.1016/j.radcr.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 02/27/2022] [Accepted: 03/02/2022] [Indexed: 11/03/2022] Open
Abstract
Coronary artery fistulas are anomalous connections between one or two coronary arteries with either a cardiac chamber or any major blood vessels (coronary sinus, superior vena cava, pulmonary veins and pulmonary artery). It is rarely reported, occurring only in 0.1%-0.2% of patients who undergo coronary angiography. We report a very rare case where myocardial ischaemia may have resulted from the presence of coronary artery fistula, significant coronary artery stenosis and severe aortic valve stenosis. Transthoracic echocardiography showed severe aortic stenosis, while coronary angiography showed a tortuous coronary artery fistula originating from the proximal left anterior descending artery, with a single opening in the main pulmonary artery. Angiography also showed significant stenosis in the middle of the left anterior descending artery. Coronary artery fistula with concomitant significant coronary atherosclerosis and severe aortic stenosis requires optimal therapeutic planning.
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19
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Tekeli Sengul S, Karasu BB. Prevalence and characteristics of coronary artery fistula in adults: coronary angiographic analysis of 18,106 patients. KARDIOLOGIIA 2022; 62:62-66. [PMID: 35692175 DOI: 10.18087/cardio.2022.5.n1901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 10/22/2021] [Accepted: 02/03/2022] [Indexed: 06/15/2023]
Abstract
Aim Coronary artery fistula (CAF) is a rarely encountered anomaly that is characterized by an abnormal connection between a coronary artery and a cardiac chamber or a great thoracic vessel. Its incidence has not been precisely established due to the large number of undiagnosed cases and it shows heterogeneity in its anatomic configuration and clinical consequences. We aimed to assess the frequency, imaging findings, and clinical features of CAF among patients in our tertiary medical center.Material and methods The angiographic data of 18,106 consecutive adult patients who underwent coronary angiography between January 2011 and June 2013 were retrospectively analyzed.Results CAF was detected in 22 patients (0.14 %). Of these, 5 patients had bilateral fistulas (23 %). 65 % of the fistulas originated from the left anterior descending coronary artery,and 53 % drained into the pulmonary artery. The left ventricle and left atrium were the only drainage sites for left-sided coronary artery fistulas. One patient with a CAF presented with non-ST elevated myocardial infarction in the absence of an evident thrombosis.Conclusion Unlike previous reports, bilateral CAFs were more commonly encountered in this study. Contrary to most of the data in the literature, more than half of the CAFs originated from the left anterior descending coronary artery and most drained into the pulmonary artery. Rare anatomic types of CAFs were also detected.
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Jiang X, Cao H, Zhang Z, Zheng T, Li X, Wu P. A Hemodynamic Analysis of the Thrombosis Within Occluded Coronary Arterial Fistulas With Terminal Aneurysms Using a Blood Stasis Model. Front Physiol 2022; 13:906502. [PMID: 35677091 PMCID: PMC9169043 DOI: 10.3389/fphys.2022.906502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/04/2022] [Indexed: 11/21/2022] Open
Abstract
Objective: The aim of this study is to numerically evaluate thrombosis risk within occluded coronary arterial fistulas (CAF) with terminal aneurysms, and provide guidance in choosing occlusion positions, with clinical observations as reference. Method: Four patients with CAF were studied, with different occlusion positions in actual treatments. Hemodynamics simulations were conducted, with blood residue predicted using the blood stasis model. Three types of models (untreated model, aneurysm-reserved model and aneurysm-removed model) were studeid for each patient. Four metrics, i.e., proportion of high oscillatory shear index (OSI), area of high OSI, old blood volume fraction (OBVF)) and old blood volume (OBV) was obtained to distinguish the thrombosis risk of different treatments (proximal or distal occlusion), comparing with the follow-up CTA. Results: For all the postopertive models, the high OBVF, high OSI(>0.3) and low time-averaged wall shear stress (TAWSS) regions were mainly at the distal fistula, indicating these regions were prone to thrombosis. The regions where blood residue remains are roughly regions of high OSI, corresponding well with clinical observations. In contrast, TAWSS failed to distinguish the difference in thrombosis risk. Absolute values (area of high OSI, OBV) can better reflect the degree of thrombosis risk between treatment types compared with percentage values (proportion of high OSI, OBVF). By comparing with the actual clinical treatments and observations, the OBV is superior to the area of high OSI in determining treatment type. Conclusion: The OBV, a volumetric parameter for blood stasis, can better account for the CAF thrombosis and reflect the degree of blood stasis compared with OSI or TAWSS, is a more appropriate metric for thrombosis in the fistula. Together with morphological parameters, the OBV could guide clinicians to formulate more appropriate surgical plans, which is of great significance for the preoperative evaluation and treatment prognosis of CAF patients.
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Affiliation(s)
- Xudong Jiang
- Artificial Organ Technology Laboratory, School of Mechanical and Electric Engineering, Soochow University, Suzhou, China
- Department of Vascular Surgery, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Haoyao Cao
- College of Architecture and Environmental Engineering, Sichuan University, Chengdu, China
- Sichuan University Yibin Park/Yibin Institute of Industrial Technology, Yibin, China
| | - Zijian Zhang
- Artificial Organ Technology Laboratory, School of Mechanical and Electric Engineering, Soochow University, Suzhou, China
| | - Tinghui Zheng
- College of Architecture and Environmental Engineering, Sichuan University, Chengdu, China
- Sichuan University Yibin Park/Yibin Institute of Industrial Technology, Yibin, China
| | - Xiaoqiang Li
- Department of Vascular Surgery, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Peng Wu
- Artificial Organ Technology Laboratory, School of Mechanical and Electric Engineering, Soochow University, Suzhou, China
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21
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Cai R, Ma X, Zhao X, Xu J, Zhu L, Ku L. CTA analysis of 482 cases of coronary artery fistula: A large-scale imaging study. J Card Surg 2022; 37:2172-2181. [PMID: 35508600 DOI: 10.1111/jocs.16500] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/13/2022] [Accepted: 03/23/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The prevalence of coronary artery fistula (CAF) based on coronary angiography has been reported. However, with the popularity of coronary computerized tomography angiography (CTA), CAFs have been found more and more by chance. The purpose of this study was to determine the prevalence and types of CAFs detected by coronary CTA, and to explore the differences in the size of fistulas, the number of complicated aneurysms, and fistulas among different types. MATERIALS AND METHODS From January 2016 to December 2020, 96,037 patients underwent coronary CTA in our hospital. The prevalence of CAF was retrospectively evaluated, The origin, course, and drainage site of CAF and coexisting abnormalities were analysed. The conventional treatments and follow-up DSCT images were also evaluated. Analyze the difference between the coronary-pulmonary artery fistula (CPAFs) group (380) and the coronary-cameral fistula (CCF) group (99). RESULTS Among 96,037 patients, 482 (0.5%) patients (male 232 and 250 female) had CAF. The types of CAF detected. The pulmonary artery was the most common site of drainage (380/482, 78.8%). Of the 99 CCFs, coronary to the left ventricle is the most common pattern in CCF (34/482, 7.0%). Single origins are more common in CAF (n = 361, 74.9%), multiple origins are more common in CPAFs than in CCF. There were statistically significant differences in the stoma diameter (2.4 ± 1.1 mm vs. 5.4 ± 4.3 mm p < .05), aneurysm complicated (85 cases [85/380] vs. 50 cases [50/99]), the size of aneurysm (8.8 ± 5.7 mm vs. 19.1 ± 11.6 mm, p < .05), and single fistula (261 [261/380] vs. 96 [96/99], p < .05). Most of the 380 CPAFs patients received conservative treatment (350/380, 92.1%), While the 59 CCF patients (59/93, 63.4%) were treated. CONCLUSIONS Different from previous reports, the prevalence of CAF in coronary CTA is 0.5%, the incidence of CPAFs is the highest, and the incidence of the left ventricular fistula is higher in CCF. Compared with CPAFs, CCF fistulas were more likely to be associated with a larger diameter of draining, larger aneurysms, single fistula pattern. Coronary artery CTA is a useful and noninvasive imaging method to detect CAF, which is of great significance for the detection of small fistulas and the surgical guidance of complex CAF.
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Affiliation(s)
- Renhui Cai
- Wuhan University of Science and Technology, Wuhan Asian Heart Hospital Imaging Centre, Wuhan, Hubei, China
| | - Xiaojing Ma
- Wuhan University of Science and Technology, Wuhan Asian Heart Hospital Imaging Centre, Wuhan, Hubei, China
| | - Xinxiang Zhao
- Department of Radiology, The Second Affifiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Juan Xu
- Wuhan University of Science and Technology, Wuhan Asian Heart Hospital Imaging Centre, Wuhan, Hubei, China
| | - Li Zhu
- Wuhan University of Science and Technology, Wuhan Asian Heart Hospital Imaging Centre, Wuhan, Hubei, China
| | - Leizhi Ku
- Wuhan University of Science and Technology, Wuhan Asian Heart Hospital Imaging Centre, Wuhan, Hubei, China
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22
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George B, Sood MR. Coronary-pulmonary artery fistula with lung hypoplasia and a bicuspid aortic valve: A case report. JRSM Cardiovasc Dis 2022; 11:20480040221082905. [PMID: 35295191 PMCID: PMC8918961 DOI: 10.1177/20480040221082905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 01/11/2022] [Accepted: 02/04/2022] [Indexed: 11/17/2022] Open
Abstract
Background With an incidence of less than 1%, a Coronary Artery to Pulmonary Artery fistula (CAPF) is a rare coronary anomaly that causes heart failure. It causes a left to right cardiac shunt. While guidelines favor surgical correction in symptomatic patients, we present a challenging case with multiple cardio-thoracic pathologies. Case Presentation We present a 38-year-old obese male with persistent atrial fibrillation (AF). He presented to our hospital in decompensated heart failure and AF with rapid ventricular response. He was found to have a CAPF, a bicuspid aortic valve and left lung hypoplasia in the presence of severely reduced left ventricular systolic dysfunction. The patient subsequently underwent various cardiac testing demonstrating advanced anatomical and physiologic involvement of his CAPF, including suggested coronary steal. Despite some indications for percutaneous or surgical referral, we optimized his AF and congestive heart failure in lieu of formulating a treatment strategy for his CAPF and other abnormalities. Conclusion This report illustrates a case of a young adult who presented in decompensated heart failure with newly diagnosed left ventricular systolic function and rapid AF, who had a triad of congenital defects including a CAPF, a bicuspid aortic valve and left lung hypoplasia. To the best of our knowledge, this triad of defects is unreported. This case highlights the clinical approach in the evaluation of a cardiac shunt and it's management strategies in the presence of multiple cardio-thoracic comorbidities.
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Affiliation(s)
- Blessen George
- Department of Medicine, Mount Sinai South Nassau, One Healthy way, Oceanside, New York, USA
- Icahn School of Medicine at Mount Sinai, New York, USA
| | - Michael R Sood
- Department of Medicine, Mount Sinai South Nassau, One Healthy way, Oceanside, New York, USA
- Division of Cardiology, Mount Sinai South Nassau
- Icahn School of Medicine at Mount Sinai, New York, USA
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23
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Mukherjee A, Pandey NN, Kumar S. "Ground-cherry" appearance of the pulmonary trunk: Incidentally detected sinoatrial nodal branch-to-pulmonary trunk fistula. J Card Surg 2022; 37:1408-1409. [PMID: 35218054 DOI: 10.1111/jocs.16357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/13/2022] [Indexed: 11/28/2022]
Abstract
We present a case of a 45-year-old man with atypical chest pain who underwent coronary computed tomography angiography which incidentally revealed a conglomerate of nondilated tortuous vessels along the inferior half of the surface of the pulmonary trunk, resulting in a "ground-cherry" like ridged appearance. Tracing these vessels proximally and distally revealed it to be arising from the sinoatrial nodal branch of the right coronary artery and distally draining into the left anterolateral aspect of the pulmonary trunk.
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Affiliation(s)
- Aprateem Mukherjee
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Niraj Nirmal Pandey
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
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Rubimbura V, Girod G, Delabays A, Meier D, Rotzinger DC, Muller O, Qanadli SD, Eeckhout É. Case Report: Coronary-Pulmonary Fistula Closure by Percutaneous Approach: Learning From Mistakes. Front Cardiovasc Med 2022; 8:779716. [PMID: 35146007 PMCID: PMC8823088 DOI: 10.3389/fcvm.2021.779716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 12/06/2021] [Indexed: 12/02/2022] Open
Abstract
Coronary-pulmonary artery fistulas (CPAF) are congenital vascular anomalies detected incidentally in most cases. When a significant left-right shunt exists, surgical, or percutaneous treatment is indicated. We describe a challenging case of CPAF closure, by percutaneous approach, in a patient symptomatic for dyspnea and evidence of a significant left-right shunt. A first attempt to close the fistula was performed implanting a vascular plug but it quickly embolized. The plug was successfully retrieved. In a second attempt, we deployed several coils before implanting the vascular plug with total closure of the fistula. The combination of plugs and coils is associated with a higher success rate of closure.
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Affiliation(s)
- Vladimir Rubimbura
- Cardiology Department, Lausanne University Hospital, Lausanne, Switzerland
- Cardiology Unit, Ensemble Hospitalier de la Côte, Morges, Switzerland
- *Correspondence: Vladimir Rubimbura
| | - Grégoire Girod
- Cardiology Department, Lausanne University Hospital, Lausanne, Switzerland
- Cardiology Department, Sion Hospital, Sion, Switzerland
| | - Alain Delabays
- Cardiology Department, Lausanne University Hospital, Lausanne, Switzerland
- Cardiology Unit, Ensemble Hospitalier de la Côte, Morges, Switzerland
| | - David Meier
- Cardiology Department, Lausanne University Hospital, Lausanne, Switzerland
| | - David C. Rotzinger
- Cardiology Department, Lausanne University Hospital, Lausanne, Switzerland
- Radiology Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Olivier Muller
- Cardiology Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Salah D. Qanadli
- Cardiology Department, Lausanne University Hospital, Lausanne, Switzerland
- Radiology Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Éric Eeckhout
- Cardiology Department, Lausanne University Hospital, Lausanne, Switzerland
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25
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Lee HJ, Kim JY. Coronary Artery Anomaly, What Radiologist Should Know? JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:84-101. [PMID: 36237368 PMCID: PMC9238192 DOI: 10.3348/jksr.2021.0169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 12/17/2021] [Accepted: 12/24/2021] [Indexed: 11/15/2022]
Abstract
심장 전산화단층촬영(이하 CT)은 현재 관상동맥기형을 진단하고, 평가하는 가장 정확한 진단 도구로 자리매김하였으며, 심장 CT 촬영 건수가 증가함에 따라 관상동맥기형을 종종 관찰할 수 있다. 본 종설은 관상동맥기형에서 영상의학과 의사들이 꼭 알아야 할 대표적인 기형의 CT 소견들에 대해 다루었다. 관상동맥기형의 종류를 3부분 즉, 기시부, 동맥 내, 그리고 연결 부위로 나누어 설명하였으며, 임상에서 볼 수 있는 대표적인 기형들 중심으로 다루었다. 특히 혈역학적 이상을 유발하거나, 급사의 위험이 있는 기형들의 CT상 위험한 해부학적 소견에 대해서는 자세히 기술하였다.
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Affiliation(s)
- Hyun Jin Lee
- Department of Radiology, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Jin Young Kim
- Department of Radiology, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
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26
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Abstract
Coronary artery fistulas are uncommon but clinically important entities that may produce symptoms and significant complications such as angina, myocardial infarction, coronary artery aneurysm formation, and congestive heart failure. Multiple fistula types have been recognized, and classification uses factors such as etiology, coronary artery origin, and drainage site. Both invasive and noninvasive imaging play an important role in the management and treatment of these patients, and often times, more than one modality is necessary for comprehensive evaluation of coronary fistulas. Recent advances in both functional and anatomic imaging will likely also play a growing role in fistula evaluation. The purpose of this article is to review the classification, pathophysiology, clinical presentations, imaging findings, treatment, and future imaging directions of coronary artery fistulas.
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27
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Firouzi A, Alemzadeh-Ansari MJ, Mohebbi B, Khajali Z, Khalilipur E, Baay M, Bayatian A, Taherian M, Khosropour A, Hosseini Z. Diverse Transcatheter Closure Strategies in Coronary Artery Fistulas A State-of-the-Art Approach. Curr Probl Cardiol 2021; 47:101010. [PMID: 34599986 DOI: 10.1016/j.cpcardiol.2021.101010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 09/22/2021] [Indexed: 12/24/2022]
Abstract
Coronary artery fistulas (CAFs) are accounted as the most congenital coronary anomalies. As their natural course is progressive dilatation of the feeder arteries and the fistula tract, so, catastrophic complications are frequently illustrated by aging. Even in those with asymptomatic small fistulas, close follow-up is mandatory to prevent subsequent sequelas. In patients with medium or large-sized fistulas, irrespective of symptoms, closure (either by surgical ligation or transcatheter closure) is recommended. In the current era of advances in the equipment and devices and also innovations in percutaneous closure techniques and preprocedural imaging, TCC is now regarded as the preferred strategy for CAF closure except in some high-risk cases. So, by appropriate case selection modalities, pre-procedural planning, and determining the closure techniques, recent small case-series studies have been reported good final angiographic and clinical results by TCC. In this article, we have introduced several transcatheter closure techniques by details; also, we have recommended more multi-center trials with long-term clinical follow-up to address the best treatment options in these patients.
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Affiliation(s)
- Ata Firouzi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Javad Alemzadeh-Ansari
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Bahram Mohebbi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Khajali
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ehsan Khalilipur
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Baay
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ayatollah Bayatian
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Maisam Taherian
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Khosropour
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Hosseini
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
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28
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Goo HW. Imaging Findings of Coronary Artery Fistula in Children: A Pictorial Review. Korean J Radiol 2021; 22:2062-2072. [PMID: 34564965 PMCID: PMC8628148 DOI: 10.3348/kjr.2021.0336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/09/2021] [Accepted: 07/21/2021] [Indexed: 11/25/2022] Open
Abstract
Coronary artery fistula, defined as an abnormal communication between the coronary arteries and a cardiac chamber (most commonly) or a thoracic great vessel, may result in hemodynamically significant problems due to vascular shunting in children. Echocardiography, cardiac catheterization, cardiac MRI, and cardiac CT may be used to evaluate coronary artery fistula in children. Recently, CT has played a pivotal role for the accurate diagnosis of coronary artery fistula in children. Surgical or interventional treatment is performed for hemodynamically significant coronary artery fistulas. In this pictorial review, the detailed imaging findings of coronary artery fistula in children are described.
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Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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29
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Kumar P. Congenital Coronary Artery-to-Pulmonary Artery Fistula with Anomalous Origin of Right Coronary Artery from Pulmonary Artery: A Case of "Double Trouble". Radiol Cardiothorac Imaging 2021; 3:e210003. [PMID: 34498004 PMCID: PMC8415169 DOI: 10.1148/ryct.2021210003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 06/04/2021] [Accepted: 06/21/2021] [Indexed: 06/13/2023]
Abstract
Congenital coronary artery fistula is a rare coronary anomaly. Its clinical significance focuses mainly on the mechanism of coronary steal phenomenon. A combination of left main (LM) coronary artery-to-main pulmonary artery (MPA) fistula with anomalous origin of right coronary artery from the pulmonary artery (ARCAPA) was encountered in a 3-month-old infant who presented with tachypnea. Evaluation with echocardiography and CT confirmed the diagnosis. The patient underwent surgical ligation of LM-to-MPA fistula with direct reimplantation of ARCAPA to aortic root. Keywords: Pediatrics, CT, CT-Angiography, Echocardiography © RSNA, 2021.
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30
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Osawa T, Ito Y, Koizumi T. Rare case of congenital coronary artery fistula coexistent and coalesced with aortopulmonary fistula. BMJ Case Rep 2021; 14:14/7/e244035. [PMID: 34301690 PMCID: PMC8311308 DOI: 10.1136/bcr-2021-244035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Coronary artery fistula (CAF) is an uncommon congenital heart disease. Furthermore, aortopulmonary fistula is a rare congenital heart disease of adult onset. We report the case of a 79-year-old man who presented with chest pain. ECG-gated cardiac CT and coronary artery angiography revealed an anomalous vessel arising from the right coronary cusp and a CAF from the left coronary descending artery. These fistulas coalesced and drained into the same portion of the pulmonary artery. Haemodynamic studies revealed that the estimated systemic-to-pulmonary flow ratio was 1.18. The mean pulmonary pressure was 14 mm Hg. We decided against surgical intervention due to his advanced age and lack of heart failure symptoms. The patient did not have any worsening heart failure and chest pain on follow-up. This was a rare case of CAF coexistent and coalesced with an aortopulmonary fistula.
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Affiliation(s)
- Takumi Osawa
- Department of Cardiovascular Medicine, Mito Medical Center, Mito, Ibaraki, Japan
| | - Yuta Ito
- Department of Cardiovascular Medicine, Mito Medical Center, Mito, Ibaraki, Japan
| | - Tomomi Koizumi
- Department of Cardiovascular Medicine, Mito Medical Center, Mito, Ibaraki, Japan
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31
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Imrani K, Amalik S, Moatassim Billah N, Nassar I. Left circumflex artery fistula to left atrium: a rare case report. Radiol Case Rep 2021; 16:1985-1987. [PMID: 34158878 PMCID: PMC8203572 DOI: 10.1016/j.radcr.2021.04.081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 12/26/2022] Open
Abstract
Coronary artery fistulas are rare congenital anomalies of coronary termination. There are 3 types: (1) cameral coronary fistulas, (2) pulmonary coronary fistulas, and (3) bronchial coronary fistulas. Left circumflex coronary artery to left atrial fistula are exceptional. Imaging, especially the CT angiogram, must establish an anatomical classification of the fistula for therapeutic purposes, by specifying its origin, its path, its size and its termination. We report a rare case of the left circumflex coronary artery to left atrial fistula in a 31 year old man, which is an uncommon presentation of coronary termination anomalies. The CT coronary angiogram must describe the origin segment of the fistula and the drainage site which have therapeutic consequences.
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Affiliation(s)
- Kaoutar Imrani
- Radiology department, Ibn Sina University Hospital, Mohammed V University, Rabat
| | - Sanae Amalik
- Radiology department, Ibn Sina University Hospital, Mohammed V University, Rabat
| | | | - Ittimade Nassar
- Radiology department, Ibn Sina University Hospital, Mohammed V University, Rabat
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32
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Yoshihara S, Yaegashi T, Matsunaga M, Kurata M, Naito M. Multimodality Imaging in a Case of Coronary to Pulmonary Artery Fistula With Multiple Aneurysms via a Vieussens Arterial Ring. Circ Cardiovasc Imaging 2021; 14:e012178. [PMID: 34034503 DOI: 10.1161/circimaging.120.012178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Shu Yoshihara
- Departments of Diagnostic Radiology (S.Y., M.N.), Iwata City Hospital, Japan
| | - Taku Yaegashi
- Radiological Technology (T.Y.), Iwata City Hospital, Japan
| | | | | | - Masaaki Naito
- Departments of Diagnostic Radiology (S.Y., M.N.), Iwata City Hospital, Japan
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Maeba S, Sunada M, Ito T, Suzuki F. Myocardial ischemia due to radical resection of complex coronary fistulas with giant aneurysms: a case report. Gen Thorac Cardiovasc Surg 2021; 69:1247-1249. [PMID: 34036486 DOI: 10.1007/s11748-021-01642-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/21/2021] [Indexed: 11/24/2022]
Abstract
A 56-year-old man underwent surgery for complex coronary artery fistulas with giant coronary aneurysms. This treatment resulted in complications and caused myocardial ischemia of the right ventricular outflow tract, resulting in repeated ventricular fibrillations. The irritability caused by this fetal arrhythmia was improved by the placement of an intra-aortic balloon pump. The case findings suggest that even careful resection of complex coronary fistulas could precipitate myocardial ischemia.
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Affiliation(s)
- Satoru Maeba
- Department of Cardiovascular Surgery, Tokyo General Hospital, 3-15-2 Egota, Nakano-ku, Tokyo, 165-0022, Japan.
| | - Masatoshi Sunada
- Department of Cardiovascular Surgery, Tokyo General Hospital, 3-15-2 Egota, Nakano-ku, Tokyo, 165-0022, Japan
| | - Takuya Ito
- Department of Cardiovascular Surgery, Tokyo General Hospital, 3-15-2 Egota, Nakano-ku, Tokyo, 165-0022, Japan
| | - Fumitaka Suzuki
- Department of Cardiovascular Surgery, Tokyo General Hospital, 3-15-2 Egota, Nakano-ku, Tokyo, 165-0022, Japan
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Reversible Pulmonary Hypertension due to Combined Fistula between the Left Anterior Descending Artery (LAD) and Pulmonary Artery and Severe Stenosis of the LAD. Case Rep Cardiol 2021; 2021:6629684. [PMID: 33763258 PMCID: PMC7952168 DOI: 10.1155/2021/6629684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/16/2021] [Accepted: 02/23/2021] [Indexed: 11/25/2022] Open
Abstract
Coronary artery fistulas are usually diagnosed accidentally without the presence of any symptoms. On the other hand, the combination of fistula between the left anterior descending artery (LAD) and pulmonary artery (PA) and severe stenosis of the LAD, as in this case report, is a potential life-threatening condition. A 72-year-old patient was treated surgically after being diagnosed with fistula between the LAD and PA, severe stenosis of the LAD, and severe pulmonary hypertension. In following paragraphs, the case of this man and significant issues regarding the development and management of coronary artery fistulas are analyzed.
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Truong T, Nguyen HTT, Phan VTX, Ly MHP, Phan VTT, Phan TA, Phan HH, Tran P. A case report of coronary pulmonary artery fistula detected by transthoracic echocardiography in an elderly patient with dyspnea. AME Case Rep 2021; 5:10. [PMID: 33623864 DOI: 10.21037/acr-20-100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 11/25/2020] [Indexed: 11/06/2022]
Abstract
Coronary pulmonary artery fistula (CPAF) is a rare entity in the population. It may present with multiple clinical settings and in various age ranges. Invasive coronary angiography (ICA), coronary computed tomography angiography (CCTA), and transthoracic echocardiography (TTE) have been reported as diagnostic tools for CPAF. Among them, TTE is rarely capable of identifying CPAF. There is no current treatment guideline as some of the interventional therapies are effective yet controversial. The therapy therefore should be individualized. We report a case of CPAF accidentally detected by TTE in a 93-year-old female who presented with acute respiratory distress on the setting of community-acquired pneumonia, diastolic heart failure, ischemic heart disease, pulmonary hypertension, chronic kidney disease, and hypertension. The patient presented with orthopnea, fever, bilateral pleuritic chest pain, and productive cough with yellowish sputum for 7 days. She had no previous chest trauma or surgical intervention. TTE demonstrated the tortuous enlargement of left coronary artery which drains into the pulmonary arterial trunk right above the pulmonary valve. As the patient was in advanced age with multiple comorbidities; we offered a conservative management including diuretic, oxygen therapy, antibiotic, antiplatelet, and statin. She recovered following a 13-day hospitalization. To our knowledge, this is the oldest case report of suspected congenital CPAF which is particularly detected by TTE.
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Affiliation(s)
- Thai Truong
- Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | | | | | | | | | - Tu Anh Phan
- Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Hannah Hue Phan
- University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Phillip Tran
- Nam Can Tho University, School of Medicine, Can Tho, Vietnam
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Patel NR, Prabhakar Bhat S, Solanki S, Bauch T, Nawaz Y. Coronary Steal in a Patient With Apical Hypertrophic Cardiomyopathy: A Rare Case of Symptomatic Coronary Artery Fistula. Cureus 2020; 12:e11793. [PMID: 33409039 PMCID: PMC7779155 DOI: 10.7759/cureus.11793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
This report describes a rare case of multiple left coronary artery to pulmonary artery/left atrial fistulae causing a coronary steal phenomenon. A 58-year-old male with apical hypertrophic cardiomyopathy was seen in an outpatient office for exertional chest pain and dyspnea and subsequently had a positive exercise nuclear stress test. Coronary angiogram revealed 70-80% mid-left anterior descending artery stenosis with multiple proximal coronary artery to left atrial/pulmonary artery fistulae. Due to symptomatic coronary artery fistulae with coronary steal phenomenon, the patient underwent surgical correction of fistulae with bypass graft to left anterior descending artery. To our knowledge, this is the first case report on co-existing apical hypertrophic cardiomyopathy and coronary artery-left atrial/pulmonary artery fistulae. This article reviews current guidelines for management of coronary artery fistula.
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Narh JT, Zahid E, Shivaraj K, Sahni S, Kariyanna PT, Khan A. Steal and strain: A case of coronary artery fistula presenting with coronary steal syndrome and underlying bronchiectasis. Respir Med Case Rep 2020; 31:101301. [PMID: 33318920 PMCID: PMC7724369 DOI: 10.1016/j.rmcr.2020.101301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 11/16/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Coronary artery fistula is a relatively rare disorder with an incidence rate of 0.05-0.9%, and the majority of fistulae are detected incidentally. Most coronary artery fistulae are congenital, and the acquired variant is very rare. Herein, we present a possible acquired coronary artery to pulmonary artery fistula, most likely secondary to bronchiectasis in the adjacent lung. We will analyze the hemodynamic significance of the fistula in this case and also seek to understand the outcomes of various treatment modalities. CASE PRESENTATION A 56-year-old male patient presented with hypoxemia secondary to acute pulmonary edema during a hypertensive emergency. He developed myocardial ischemia after treatment with diuretics and nitroglycerin, due to shunting of blood from the right coronary artery to the right lower lobe branch of the right pulmonary artery, via the fistula. This resulted in coronary steal syndrome. Coronary angiogram confirmed the fistula connecting the right coronary artery to the right lower lobe branch of the right pulmonary artery. An attempt at coil embolization was unsuccessful due to the inability to advance the microcatheter beyond the fistula. DISCUSSION The majority of coronary artery fistulae are asymptomatic as they are hemodynamically not significant and are incidentally detected by coronary angiography, CT angiogram, echocardiogram or multi-detector row computed tomography (MDCT) with 3D reconstruction. The development of congenital fistula can be explained by the Hackensellner involution-persistence hypothesis, but the anatomy in this case and the bronchiectasis in the part of the lung adjacent to the fistula makes an acquired cause very likely due to local inflammation and the age of patient at initial diagnosis. An initial diagnosis of bronchiectasis was made at age 51, which was 5 years prior to the detection of the coronary artery fistula in this patient. Symptoms have been described mostly in the elderly and include chest pain, dyspnea, fatigue, syncope, and palpitations. Such symptomatic fistula should be treated either by percutaneous transluminal embolization or surgical ligation. CONCLUSION This is a unique case of acquired coronary to pulmonary artery fistula in the setting of bronchiectasis in a patient in which PTE was attempted and failed. More research is required to understand the pathophysiology of acquired fistula. The decision regarding the method of closure should be individualized and decided on a case by case basis.
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Affiliation(s)
- Joshua Tetteh Narh
- Dept. of Internal Medicine, Brookdale Hospital Medical Center, Brooklyn, NY, USA
| | - Erum Zahid
- Dept. of Pulmonary and Critical Care Medicine, Brookdale Hospital Medical Center, Brooklyn, NY, USA
| | - Kiran Shivaraj
- Dept. of Internal Medicine, Brookdale Hospital Medical Center, Brooklyn, NY, USA
| | - Sonu Sahni
- Dept. of Internal Medicine, Brookdale Hospital Medical Center, Brooklyn, NY, USA
| | | | - Abdullah Khan
- Dept. of Cardiology, Brookdale Hospital Medical Center, Brooklyn, NY, USA
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Fistula from left main coronary artery to pulmonary trunk. Neth Heart J 2020; 28:557-558. [PMID: 32157580 PMCID: PMC7494690 DOI: 10.1007/s12471-020-01405-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Fukui T, Tanaka K, Ogasawara N, Hasegawa S. Complex coronary pulmonary artery fistulae with a large aneurysm: a rare anomaly treated with surgery. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 4:1-2. [PMID: 33426436 PMCID: PMC7780432 DOI: 10.1093/ehjcr/ytaa317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/16/2020] [Accepted: 08/13/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Tomoki Fukui
- Department of Cardiology, Japan Community Healthcare Organization Osaka Hospital, 4-2-78, Fukushima, Fukushima-Ku, Osaka City, Osaka 553-0003, Japan
| | - Kenji Tanaka
- Department of Cardiovascular Surgery, Japan Community Healthcare Organization Osaka Hospital, 4-2-78, Fukushima, Fukushima-Ku, Osaka City, Osaka 553-0003, Japan
| | - Nobuyuki Ogasawara
- Department of Cardiology, Japan Community Healthcare Organization Osaka Hospital, 4-2-78, Fukushima, Fukushima-Ku, Osaka City, Osaka 553-0003, Japan
| | - Shinji Hasegawa
- Department of Cardiology, Japan Community Healthcare Organization Osaka Hospital, 4-2-78, Fukushima, Fukushima-Ku, Osaka City, Osaka 553-0003, Japan
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40
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Itagane M, Kinjo K, Hirata K. A continuous murmur in an elderly woman. Eur Heart J Case Rep 2020; 4:1. [PMID: 32974455 PMCID: PMC7501911 DOI: 10.1093/ehjcr/ytaa245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/09/2020] [Accepted: 07/03/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Masaki Itagane
- Division of General Internal Medicine, Okinawa Chubu Hospital, 281 Miyazato, Uruma City, Okinawa 904-2293, Japan
| | - Kiyoshi Kinjo
- Division of General Internal Medicine, Okinawa Chubu Hospital, 281 Miyazato, Uruma City, Okinawa 904-2293, Japan
| | - Kazuhito Hirata
- Division of Cardiology, Okinawa Chubu Hospital, 281 Miyazato, Uruma City, Okinawa 904-2293, Japan
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Kim H, Beck KS, Choe YH, Jung JI. Coronary-to-Pulmonary Artery Fistula in Adults: Natural History and Management Strategies. Korean J Radiol 2020; 20:1491-1497. [PMID: 31606954 PMCID: PMC6791815 DOI: 10.3348/kjr.2019.0331] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 07/15/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the natural course of coronary-to-pulmonary artery fistula (CPAF) detected on coronary computed tomography angiography (CCTA) and to propose potential treatment strategies. MATERIALS AND METHODS In this retrospective multicenter study, we assessed the CCTA reports of 188 CPAF patients evaluated between March 2009 and June 2016. Fifty-seven patients were excluded because their follow-up (FU) periods were less than 2 years. Information regarding demographic characteristics, past history, treatment method, and the occurrence of major adverse cardiac events (MACE) during the FU period was collected. We analyzed the morphologic features of CPAF and the various factors associated with surgical treatment. Patients who had undergone FU CCTA after being diagnosed with CPAF were assessed for the presence of morphological changes on FU imaging. RESULTS The median age of the study population was 63.0 years (range, 57.0-72.0 years), and the median FU period was 5.72 years (range, 4.08-6.96 years). The most common origin of the CPAF was both coronary arteries in 76 (58.0%) cases. An aneurysm or aneurysms was/were present in 41 (31.3%) cases. Fifty-four (41.2%) fistulas were less than 2 mm in size. Eight patients underwent surgery, and 123 (93.9%) patients received optimal medical treatment (OMT). The fistula size was significantly different between the two treatment groups (p = 0.013) and was the only factor associated with surgical treatment (odds ratio = 1.14, p = 0.021). Only one patient in the OMT group reported MACE during the FU period due to preexisting coronary artery disease. Twenty-nine patients (22.1%) underwent FU CCTA after CPAF diagnosis, with a median FU period of 3.81 years. None of the patients in the OMT group demonstrated morphological changes in the CPAF on FU imaging. CONCLUSION Most CPAFs identified on CCTA have a favorable prognosis. Observation with OMT is usually an appropriate strategy. Fistula size is a possible determinant for surgical treatment.
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Affiliation(s)
- Hokun Kim
- Department of Radiology, Seoul St. Mary's Hospital, School of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyongmin Sarah Beck
- Department of Radiology, Seoul St. Mary's Hospital, School of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yeon Hyeon Choe
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Im Jung
- Department of Radiology, Seoul St. Mary's Hospital, School of Medicine, The Catholic University of Korea, Seoul, Korea.
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42
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Baggio TC, Sebold L, Oliveira ICD. Case Report: Surgical Treatment of High-Flow Coronary Fistulas for the Pulmonary Artery. Braz J Cardiovasc Surg 2020; 35:392-395. [PMID: 31165615 PMCID: PMC7299589 DOI: 10.21470/1678-9741-2018-0327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Coronary fistulas are rare anomalies that can affect approximately 1% of the population, presenting few specific symptoms, and are often found occasionally in coronary angiography. Here we describe the case of a 61-year-old patient with complaints of precordialgia and dyspnea since adolescence, with late diagnosis of coronary fistulas with drainage to the pulmonary artery, and with unsuccessful percutaneous treatment. Therefore, she underwent open surgery for the correction of the already known fistulas, in addition to the hemangioma involving such vessels, which made the understanding and resolution of this case more complex.
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Affiliation(s)
- Thales Cantelle Baggio
- Hospital e Maternidade Jaraguá Jaraguá do Sul SC Brazil Hospital e Maternidade Jaraguá, Jaraguá do Sul, SC, Brazil
| | - Larissa Sebold
- Universidade Regional de Blumenau Ringgold Standard Institution Blumenau SC Brazil Universidade Regional de Blumenau, Ringgold Standard Institution, Blumenau, SC, Brazil
| | - Igor Cordeiro de Oliveira
- Universidade Regional de Blumenau Ringgold Standard Institution Blumenau SC Brazil Universidade Regional de Blumenau, Ringgold Standard Institution, Blumenau, SC, Brazil
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43
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Lee SH, Ko TY, Cho SH. Unusual Communication between the Pulmonary Artery and Vieussens' Arterial Ring Causing Infective Endocarditis. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2019; 52:425-427. [PMID: 31832380 PMCID: PMC6901185 DOI: 10.5090/kjtcs.2019.52.6.425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 08/20/2019] [Accepted: 08/27/2019] [Indexed: 11/16/2022]
Abstract
Coronary artery fistula is an abnormal communication between the coronary artery and the cardiac chambers. In particular, an abnormal connection between the conus branch of the right coronary artery and the proximal left anterior descending coronary artery is defined as Vieussens' arterial ring. Coronary artery fistulas are usually asymptomatic, but some can cause complications such as infective endocarditis. Here, we report a case of Vieussens' arterial ring causing infective endocarditis with severe mitral regurgitation.
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Affiliation(s)
- Sang Ho Lee
- Department of Thoracic and Cardiovascular Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Taek Yong Ko
- Department of Thoracic and Cardiovascular Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Seong Ho Cho
- Department of Thoracic and Cardiovascular Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
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44
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Li N, Zhao P, Wu D, Liang C. Coronary artery fistulas detected with coronary CT angiography: a pictorial review of 73 cases. Br J Radiol 2019; 93:20190523. [PMID: 31638419 DOI: 10.1259/bjr.20190523] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Coronary artery fistulas (CAFs) are abnormal connections of the coronary arteries that bypass the myocardial capillary bed and terminate into chambers of the heart or major blood vessels. CAFs are rare, and most of them are congenital. Because CAFs can be asymptomatic and detected incidentally, the true incidence is difficult to evaluate. CAFs usually have various and complicated image features, and the clinical symptoms mainly depend on the size, origin and drainage site of the fistulas. Thus, accurate imaging assessment of these characteristics is crucial for therapeutic planning and post-operative evaluation. Due to the high temporal and spatial resolution, coronary CT angiography has recently become more widely used in cardiovascular disease diagnosis, and more asymptomatic CAFs are accidentally found. Furthermore, with multiplanar reconstruction images, some complicated and subtle structures can be displayed more accurately. In this article, we reviewed the imaging features of CAFs on coronary CT angiography, mainly focusing on the pre- and post-operative anatomy displaying of these abnormalities.
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Affiliation(s)
- Ning Li
- Shandong Medical Imaging Research Institute, Shandong University, Jinan, PR China
| | - Peng Zhao
- Department of Radiology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, PR China
| | - Dawei Wu
- Shandong Medical Imaging Research Institute, Shandong University, Jinan, PR China
| | - Changhu Liang
- Shandong Medical Imaging Research Institute, Shandong University, Jinan, PR China
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45
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Yeung DF, Kiamanesh O, Girgis H, Hong J, Turaga M, Gin K, Wong GC, Janusz M, Tsang MYC, Tsang TSM, Nair P, Jue J. Rupture of a Coronary Artery Aneurysm and Fistula to the Pulmonary Artery. Circ Cardiovasc Imaging 2019; 12:e009516. [PMID: 31522553 DOI: 10.1161/circimaging.119.009516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Darwin F Yeung
- Division of Cardiology (D.F.Y., O.K., H.G., M.T., K.G., G.C.W., M.Y.C.T., T.S.M.T., P.N., J.J.), University of British Columbia, Vancouver, Canada
| | - Omid Kiamanesh
- Division of Cardiology (D.F.Y., O.K., H.G., M.T., K.G., G.C.W., M.Y.C.T., T.S.M.T., P.N., J.J.), University of British Columbia, Vancouver, Canada
| | - Hany Girgis
- Division of Cardiology (D.F.Y., O.K., H.G., M.T., K.G., G.C.W., M.Y.C.T., T.S.M.T., P.N., J.J.), University of British Columbia, Vancouver, Canada
| | - Jonathan Hong
- Department of Cardiovascular Surgery (J.H., M.J.), University of British Columbia, Vancouver, Canada
| | - Mansi Turaga
- Division of Cardiology (D.F.Y., O.K., H.G., M.T., K.G., G.C.W., M.Y.C.T., T.S.M.T., P.N., J.J.), University of British Columbia, Vancouver, Canada
| | - Kenneth Gin
- Division of Cardiology (D.F.Y., O.K., H.G., M.T., K.G., G.C.W., M.Y.C.T., T.S.M.T., P.N., J.J.), University of British Columbia, Vancouver, Canada
| | - Graham C Wong
- Division of Cardiology (D.F.Y., O.K., H.G., M.T., K.G., G.C.W., M.Y.C.T., T.S.M.T., P.N., J.J.), University of British Columbia, Vancouver, Canada
| | - Michael Janusz
- Department of Cardiovascular Surgery (J.H., M.J.), University of British Columbia, Vancouver, Canada
| | - Michael Y C Tsang
- Division of Cardiology (D.F.Y., O.K., H.G., M.T., K.G., G.C.W., M.Y.C.T., T.S.M.T., P.N., J.J.), University of British Columbia, Vancouver, Canada
| | - Teresa S M Tsang
- Division of Cardiology (D.F.Y., O.K., H.G., M.T., K.G., G.C.W., M.Y.C.T., T.S.M.T., P.N., J.J.), University of British Columbia, Vancouver, Canada
| | - Parvathy Nair
- Division of Cardiology (D.F.Y., O.K., H.G., M.T., K.G., G.C.W., M.Y.C.T., T.S.M.T., P.N., J.J.), University of British Columbia, Vancouver, Canada
| | - John Jue
- Division of Cardiology (D.F.Y., O.K., H.G., M.T., K.G., G.C.W., M.Y.C.T., T.S.M.T., P.N., J.J.), University of British Columbia, Vancouver, Canada
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Xu H, Wang D, Li W, Ma L, Guo X, Ni Y. Three-dimensional visualization technology in coronary-pulmonary artery fistula. J Card Surg 2019; 34:1094-1096. [PMID: 31376221 DOI: 10.1111/jocs.14175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 06/17/2019] [Accepted: 06/23/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Hongfei Xu
- Department of Cardiothoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Dongfei Wang
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Weidong Li
- Department of Cardiothoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Liang Ma
- Department of Cardiothoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaogang Guo
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yiming Ni
- Department of Cardiothoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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47
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Seitz A, Schäfer S, Backes M, Mahrholdt H, Ong P. Giant Aneurysm of a Coronary-Pulmonary Artery Fistula: A Rare Cause of a Diastolic Murmur. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2019. [DOI: 10.15212/cvia.2019.0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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48
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Liu X, Zhang L, Qi Z, Fan M, Ge J. The characteristics of coronary-pulmonary artery fistulas and the effectivity of trans-catheter closure: a single center experience. J Thorac Dis 2019; 11:2808-2815. [PMID: 31463109 DOI: 10.21037/jtd.2019.06.60] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Due to the low prevalence, the optimal treatment strategy of coronary-pulmonary artery fistula (CPF) remains unclear, and there are no established therapeutic guidelines available. The purpose of this study is to investigate the characteristics of CPF, and evaluate the effectivity of trans-catheter closure (TCC) for CPFs. Methods Patients with CPFs were retrospectively reviewed and enrolled according to the inclusion criteria. The data of clinical manifestations, physical signs, electrocardiogram (ECG), echocardiography, coronary CTA, coronary angiography and intervention procedure were collected. The telephone follow-up was conducted to evaluate the prognosis. Results The most common presenting complaint was dyspnea (n=21, 48.84%), followed by chest pain (n=10, 23.36%), palpitation (n=6, 13.95%), dizziness (n=3, 6.98%), and syncope (n=3, 6.98%). Most patients were coupled with single fistula (n=17, 39.53%) or two fistulas (n=23, 53.49%). Thirty fistulas (41.67%) involved the left anterior descending (LAD) artery, 28 fistulas (38.89%) involved the right coronary, 9 fistulas (12.50%) involved the left main trunk, and 5 fistulas (6.94%) involved the circumflex branch. Most of the fistulous tracts originated within the proximal one-third of the coronary arteries, only 6 fistulous tracts (8.33%) originated from the distal segment of the coronary arteries. The size of fistulas arranged from 1 mm to 8 mm, with an average of 3.45 mm. Thirty-five patients (81.40%) with 63 fistulas (87.50%) were successfully treated by percutaneous transcatheter closure. Thirty-eight patients accepted the 6-month follow-up, 36 patients (94.74%) were asymptomatic and 2 patients (5.26%) with palpitation. In conclusion, patients with more fistulas, larger fistula diameter and more severe left-to-right shunt are always coupled with more obvious clinical manifestations. The trans-catheter coil embolization is an effective method for the closure of CPFs. Conclusions patients with more fistulas, larger fistula diameter and more severe left-to-right shunt are always coupled with more obvious clinical manifestations. The trans-catheter coil embolization is an effective method for the closure of CPFs.
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Affiliation(s)
- Xin Liu
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
| | - Lei Zhang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
| | - Zhiyong Qi
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
| | - Mengkang Fan
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
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49
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Zucker EJ. Cross-sectional imaging of congenital pulmonary artery anomalies. Int J Cardiovasc Imaging 2019; 35:1535-1548. [PMID: 31175525 DOI: 10.1007/s10554-019-01643-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 05/31/2019] [Indexed: 02/06/2023]
Abstract
Congenital pulmonary artery (PA) anomalies comprise a rare and heterogeneous spectrum of disease, ranging from abnormal origins to complete atresia. They may present in early infancy or more insidiously in adulthood, often in association with congenital heart disease such as tetralogy of Fallot or other syndromes. In recent years, cross-sectional imaging, including computed tomography (CT) and magnetic resonance imaging (MRI), has become widely utilized for the noninvasive assessment of congenital PA diseases, supplementing echocardiography and at times supplanting invasive angiography. In this article, modern CT and MRI techniques for imaging congenital PA disorders are summarized. The key clinical features, cross-sectional imaging findings, and treatment options for the most commonly encountered entities are then reviewed. Emphasis is placed on the ever-growing role of cross-sectional imaging options in facilitating early and accurate diagnosis and tailored treatment.
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Affiliation(s)
- Evan J Zucker
- Department of Radiology, Stanford University School of Medicine, 725 Welch Road, Stanford, CA, 94305, USA.
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Liu H, Mei J, He Y, Jiang Z, Tang M. Minimally Invasive Surgery for Coronary-Pulmonary Artery Fistula Via Parasternal Minithoracotomy. Heart Lung Circ 2019; 28:e79-e82. [DOI: 10.1016/j.hlc.2018.04.307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 04/17/2018] [Indexed: 11/30/2022]
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