ABSTRACT
Coronary arteriovenous fistula (CAVF) is defined as an abnormal communication between the coronary artery and a cardiac cavity or a major blood vessel. It is the most common congenital anomaly of the coronary arteries, but it is relatively rare, accounting for only approximately 0.4% of all congenital heart diseases. Most cases of CAVF are clinically asymptomatic in young patients, but with increasing age, symptoms begin to appear and surgical treatment is required. In rare cases of CAVF, however, symptoms may appear in the neonatal period and early surgery may be required. In this article, we report the case of a 12-day-old patient diagnosed after birth with CAVF between the aneurysmatic left anterior descending artery and the right ventricle. This patient required early surgical intervention due to concerns about worsening heart failure and developing coronary artery ischemia. Although various surgical options were considered, we opted for an arteriotomy of the left anterior descending artery and closed the fistula with two autologous pericardial patches. There has been no signs of postoperative ischemic changes or enlargement of the coronary aneurysm during the 4 years of follow up, and careful monitoring will continue.
ABSTRACT
An 83-year-old man was transferred to our hospital with cardiac tamponade and suspected cardiac tumor detected by enhanced CT. Coronary angiography showed a coronary aneurysm of 50 mm ID on the left circumflex artery. An emergency surgery was performed to excise the aneurysm, and a fresh thrombus occupying the efferent artery was observed. Both the afferent and efferent vessels were closed by suture. The patient made an otherwise uneventful recovery. This case featured a fresh red thrombus formed in fistulous outflow of the coronary aneurysm that seemed a direct cause of rupture.
ABSTRACT
Coronary arteriovenous fistula is a more prevalent, hemodynamically significant congenital malformation. Both coronary arteries arise normally from their aortic sinuses, but the branches of fistula communicate directly with cardiac chamber, pulmonary trunk, coronary sinus, superior vena cava, or pulmonary vein. Fistula associated with coronary aneurysm is an uncommon finding. We report a rare case of 76-year-old female patient who had a coronary arteriovenous fistula with giant coronary artery aneurysm. This case is clearly diagnosed by echocardiography, three-dimensional computed tomography (3D-CT), and coronary angiography (CAG).
Subject(s)
Aged , Female , Humans , Aneurysm , Arteriovenous Fistula , Coronary Aneurysm , Coronary Angiography , Coronary Sinus , Coronary Vessels , Echocardiography, Three-Dimensional , Fistula , Pulmonary Veins , Sinus of Valsalva , Vena Cava, SuperiorABSTRACT
PURPOSE: Four pediatric patients with congenital coronary arteriovenous fistula (CAVF) were reported to remind pediatric practitioners and cardiologists of its diagnosis and management. MATERIALS AND METHODS: Four pediatric patients with congenital CAVF from June 1999 to November 2007 were included in this retrospective study. Study modalities included reviews of patients' profiles of clinical features, chest radiograph, Doppler echocardiography, cardiac catheterization with angiography, myocardial perfusion scan, and computed tomography. RESULTS: All 4 patients were symptomatic. The clinical symptoms and signs were feeding problem, continuous murmur, tachycardia, tachypnea, cardiomegaly, and exertional chest pain. Myocardial enzyme was elevated in 1 patient. Echocardiography showed dilatation of the coronary artery in all 4 patients, and traced down its origin in 3 and drainage in 4. The fistulas originated from the right coronary artery in 2 patients and left coronary artery in 2, and were drained into the right ventricle in 2, right atrium in 1, and pulmonary artery in 1. Single left coronary artery was found in 1 patient. The pulmonary-to-systemic blood flow ratios ranged from 1.2 to 2.5. Transcatheter coil occlusion was successfully performed in 4 patients through a coaxial delivery system. The symptoms and signs of congestive heart failure and myocardial ischemia disappeared after the procedure. CONCLUSION: Diagnosis of congenital CAVF could be achieved by appreciation of continuous murmur over area unusual for the ductus, and by scrupulous examination of echocardiography as well as angiography of the coronary artery through which coaxial transcatheter coil occlusion could be performed successfully.
Subject(s)
Child , Child, Preschool , Female , Humans , Infant , Male , Arteriovenous Fistula/complications , Coronary Angiography , Coronary Circulation , Coronary Vessel Anomalies/complications , Embolization, Therapeutic , Heart Failure/etiology , Myocardial Ischemia/etiologyABSTRACT
A coronary arteriovenous (AV) fistula consists of a communication between a coronary artery and a cardiac chamber, a great artery or the vena cava. It is the most common anomaly that can affect coronary perfusion. Yet bilateral involvement of a coronary fistula, constitutes an uncommon subgroup of coronary AV fistulas. We herein report on a case of bilateral coronary AV fistula that was coexistent with variant angina originating from the distal right ventricular branch of the right coronary artery and the distal septal branch of the left anterior descending artery, and the latter drained into the right ventricle.
Subject(s)
Female , Humans , Middle Aged , Angina Pectoris, Variant/etiology , Coronary Vessel Anomalies/complications , Heart Ventricles/abnormalities , Vascular Fistula/complicationsABSTRACT
We report the successful percutaneous closure of a large coronary fistula from the right coronary artery to the right ventricle in a 4-years-old boy using the Amplatzer vascular plug. The device was positioned and deployed via the arterial system.It allows a smaller delivery profile through small sheath or guide catheters and the technique appeared to be easy, safe, and effective.
Subject(s)
Humans , Male , Arteriovenous Fistula , Catheters , Coronary Vessels , Fistula , Heart VentriclesABSTRACT
Congenital coronary arteriovenous fistula (CAVF) is a rare condition which is characterized by abnormal communication of the coronary artery with the right ventricle, right atrium, left atrium, left ventricle or pulmonary artery. In this paper, we report a case of a 68-year-old woman complaining of resting chest pain for one week. Initially, after performing a coronary arteriogram, the case was diagnosed as a CAVF combined with a pulmonary artery aneurysm. However, a multidetector-row CT (MDCT) was also performed, and the structure initially diagnosed as a pulmonary artery aneurysm was identified as a dilated pulmonary sinus. Subsequently, the patient was treated successfully with a simple ligation.
Subject(s)
Aged , Female , Humans , Aneurysm , Arteriovenous Fistula , Chest Pain , Coronary Vessels , Heart Atria , Heart Ventricles , Ligation , Pulmonary ArteryABSTRACT
A congenital coronary arteriovenous fistula is a rare condition, which is an abnormal communication of the coronary artery with the right or left ventricle, the right or left atrium or the pulmonary artery. A coronary arteriovenous fistula, complicated with a pulmonary aneurysm, is quite uncommon. A case of 68-year-old woman, complaining of resting chest pain for 1 week, is reported. The coronary arteriovenous fistula associated, with a pulmonary aneurysm, was confirmed by coronary angiography and multidetector-row helical CT (MDCT), and was surgically ligated.
Subject(s)
Aged , Female , Humans , Aneurysm , Arteriovenous Fistula , Chest Pain , Coronary Angiography , Coronary Vessels , Heart Atria , Heart Ventricles , Pulmonary Artery , Tomography, Spiral ComputedABSTRACT
In general, coronary steal is defined as a fall in blood flow toward a certain vascular region in favor of another area during arteriolar vasodilatation. The coronary artery fistulae is an unusual abnormality in the general population, but is the most common abnormality of the coronary arteries that are ED: Either the ARTERIES ARE hemodynamically significant, or the ABNORMALITY IS hemodynamically significant. Hemodynamically significant. We experienced a 58-year-old male patient with intermittent chest pain at rest. Coronary angiography showed coronary artery fistulae on the LCX and RCA and retrograde flow from the LAD to LCX. Retrograde flow caused coronary artery steal syndrome on LAD territory. A stress/rest MIBI myocardial scan showed reversible ischemia on the LAD territory. He underwent an operation for the coronary artery fistulae, and has since been doing well without chest pain.
Subject(s)
Humans , Male , Middle Aged , Arteries , Arteriovenous Fistula , Chest Pain , Coronary Angiography , Coronary Vessels , Fistula , Ischemia , VasodilationABSTRACT
Communication between coronary arteries and cardiac chambers or large vessels is unusual type of congenital malformation. Aneurysmal formation of a coronary arteriovenous fistula is even rare. We report a case of 83-year-old women with giant aneurysm of the coronary arteriovenous fistula from the left anterior descending coronary artery treated by percutaneous deployment of embolization coil.
Subject(s)
Aged, 80 and over , Female , Humans , Aneurysm , Arteriovenous Fistula , Coronary Vessels , Embolization, TherapeuticABSTRACT
Congenital coronary arteriovenous fistula is a rare condition which is an abnormal communication of the coronary artery with the right ventricle, right atrium, left atrium or left ventricle. Coronary artery aneurysm is an uncommon disease which is defined as coronary dilatation which exceeds the diameter of normal adjacent segments or the diameter of the patient's largest coronary vessel by 1.5 times. In young ages, symptoms are unusual, but significant symptoms and complications such as congestive heart failure, subacute bacterial endocarditis, coronary steal syndrome, aneurysm formation, rupture, and pulmonary hypertension may appear among the older age group. We report a case of giant aneurysm of a congenital coronary arteriovenous fistula between left co-ronary artery and right ventricular outflow tract with significant left to right shunt confirmed in a 84-year old female with a brief review of literature.
Subject(s)
Aged, 80 and over , Female , Humans , Aneurysm , Arteries , Arteriovenous Fistula , Coronary Aneurysm , Coronary Vessels , Dilatation , Endocarditis, Subacute Bacterial , Heart Atria , Heart Failure , Heart Ventricles , Hypertension, Pulmonary , RuptureABSTRACT
Congenital coronary arteriovenous fistulas represent abnormal communication between coronary arteries and any cardiac chambers, pulmonary artery, coronary sinus, superior vena cava or pulmonary vein. A 60 year-old male patient presented with severe effort-induced chest pain radiating to left arm. Resting electrocardiogram was normal and anterior ischemia was demonstrated on stress myocardial SPECT. Coronary angiogram reve-aled very long and tortuous coronary arteriovenous fistulas originated from the left circumflex and right coronary artery, which drained into intercostal arteries. Proximal segment of left anterior descending artery stenosed about 50%. Both coronary artery fistulas were ligated and left internal mammary artery was grafted into left anterior descending artery. After surgical correction he has no cardiovascular events on 7-month clinical follow-up.
Subject(s)
Humans , Male , Middle Aged , Arm , Arteries , Arteriovenous Fistula , Chest Pain , Coronary Sinus , Coronary Vessels , Electrocardiography , Fistula , Follow-Up Studies , Ischemia , Mammary Arteries , Pulmonary Artery , Pulmonary Veins , Tomography, Emission-Computed, Single-Photon , Transplants , Vena Cava, SuperiorABSTRACT
BACKGROUND: Coronary arterioveonus fistula(CAVf) is a rare congerital coronary artery anomaly in adults. CAVF is related with some clinincal significances, such as angina, congestive heart failure and bacterial endocarditis. METHOD: We analyzed clincial characteristics in 10 patients(mean age=52.1 +/- 12.5 year) of adult CAVF, who were diagnosed as CAVF by coronary angiogram from Jan. 1993 to Mar. 1997 in Chonnam University Hosptial. RESULTS: Five out of 10 patients complained of chest pain, four had dyspnea and one had hemoptysis. In seven patients, arteries of CAVF were originated from left coronary arteries, from right coronary artery in one, and from both coronary arteries in two. CAVF was drained into pulmonary artery in six patients, right ventricle in two, right atrium in one, and left ventricle in one. CONCLUSION: Chest pain and dyspnea are common in symptomatic patients with CAVF are originated most commonly from left coronary arteries and drained into pulomonary arteries in Korean adults.
Subject(s)
Adult , Humans , Arteries , Arteriovenous Fistula , Chest Pain , Coronary Vessels , Dyspnea , Endocarditis, Bacterial , Heart Atria , Heart Failure , Heart Ventricles , Hemoptysis , Pulmonary ArteryABSTRACT
We report a case of 70-year-old woman who had bilateral coronary arteriovenous fistula(CAVF) and treated with percutaneous transcatheter coil embolization. Enlarged LV and reduced global LV systolic function were demonstrated on transthoracic echocardiography. Coronary angiography revealed a large coronary arteriovenous fistula from the right coronary artery to the main pulmonary artery and a small fistula from the left coronary artery to the main pulmonary artery. Percutaneous transcatheter coil embolization for CAVF from the right coronary artery to the main pulmonary artery was successfully performed with symptomatic improvement.
Subject(s)
Aged , Female , Humans , Arteriovenous Fistula , Coronary Angiography , Coronary Vessels , Echocardiography , Embolization, Therapeutic , Fistula , Pulmonary ArteryABSTRACT
A coronary arteriovenous fistula consists of a communication between a coronary artery and a cardiac chamber, a great artery or the vena cava. It is the most common anomaly that can affect coronary perfusion. Bilateral involvement of coronary fistula, however, constitutes an uncommon subgroup of coronary arteriovenous fistulas. We report a case which shows a rare occurrence of bilateral coronary arteriovenous fistula coexistent with atrial septal defect and pulmonic stenosis.
Subject(s)
Humans , Male , Arteries/abnormalities , Arteriovenous Fistula/complications , Coronary Vessel Anomalies/complications , Heart Septal Defects, Atrial/complications , Middle Aged , Pulmonary Valve Stenosis/complications , Veins/abnormalitiesABSTRACT
Coronary arteriovenous fistula is relatively rare disease and originates more commonly in the right than in the left cononary artery. We report one case of cononary arteriovrnous fistula which we have experienced recently in 22 years old female, who has complained of dyspnea on exertion and intermittent anterior chest pain radiating to the left shoulder for several years. It was detected by transthoracic and transesophageal echocardiography and confirmed by cardiac catheterization and coronary angiography. In this case, the fistula was originated from the right coronary artery and drained into the posterior wall of the right ventricle, the coronary artery was dilated(diameter=1.5cm) and tortuous and significant shunt was measured(Qp/Qs=2.31). The opening of the fistula draining into right ventricle was obliterated with sutures.
Subject(s)
Female , Humans , Young Adult , Arteries , Arteriovenous Fistula , Cardiac Catheterization , Cardiac Catheters , Chest Pain , Coronary Angiography , Coronary Vessels , Dyspnea , Echocardiography , Echocardiography, Transesophageal , Fistula , Heart Ventricles , Rare Diseases , Shoulder , SuturesABSTRACT
A 43-year-old female patient with a congenital right coronary artery to right atrial fistula presented as congestive heart failure and aortic valve infective endocarditis. The diagnosis was made on the basis of echocardiography, especially TEE and confirmed by tight heart catheterization & aortography. She underwent aortic valve replacement due to severe aortic valve regurgitation with vegetations, fistulectomy and coronary aneurysmorrhaphy. The postoperative course was uneventful. She was treated with antibiotics because of infective endocarditis for 6 weeks. At present she remains well and visits out patient clinic regularly for oral anticoagulation without problem.
Subject(s)
Adult , Female , Humans , Anti-Bacterial Agents , Aortic Valve , Aortography , Arteriovenous Fistula , Cardiac Catheterization , Cardiac Catheters , Coronary Vessels , Diagnosis , Echocardiography , Endocarditis , Estrogens, Conjugated (USP) , Fistula , Heart FailureABSTRACT
Twelve children, 6 boys and 6 girls, with congenital coronary arteriovenous fistulas were retrospectively studied. The diagnoses were made at ages ranging from 2 days to 9 years. Three (twenty five per cent) of the patients had congestive heart failure, while the others had no symptoms. Abnormal physical findings included bounding pulse 9 cases (75 per cent), continuous murmur 7 case (58 per cent), pansystolic murmur 3 cases (25 per cent), and to and from murmur 2 cases (17 per cent). Cardiomegaly and increased pulmonary vascularity were demonstrated in the chest X-ray in 66 per cent of the patients. Electrocardiograms showed left ventricular hypertrophy in 58 percent of the patients. Provisional diagnoses of small ventricular septal defect, patent ductus arteriosus or catheterization were necessary in making definite diagnoses in which average Qp : Qs was 1.7:1. Three patients (25 per cent) had other associated lesions i.e. patent ductus arteriosus and/or atrial septal defect. Ten patients received surgical treatment with good results.
ABSTRACT
In a 52-year-old man who presented with acute myocardial infarction, dual coronary arteriovenous fistulas from the right coronary artery and left circumflex artery both which drained into the coronary sinus were detected on coronary arteriography.This is the first case of dual coronary arteriovenous fistulas draining into the coronary sinus.
Subject(s)
Humans , Middle Aged , Arteries , Arteriovenous Fistula , Coronary Sinus , Coronary Vessels , Myocardial InfarctionABSTRACT
We present a case of giant coronary arteriovenous fistula between left main coronary artery and pulmonary artery in a 60-year-old female who presented with anginal symptom. Dobutamine stress echocardiography and myocardial perfusion scan with (99m)Tc-MIBI revealed a reversible perfusion defect in the septal region. Coronary angiography demonstrated a giant coronary arteriovenous fistula origination from the left main coronary artery and draining into the pulmonary artery. This appears to be the first case in which dobutamine stress echocardiography and myocardial perfusion scan with (99m)Tc-MIBI demonstrated myocardial ischemia due to coronary steal in patient with a coronary arteriovenous fistula.