A Fistula between Coronary and Main Pulmonary Arteries with Chest Tightness

Masashi Kawabori^1*, Atsushi Kurata²

¹Division of Cardiac Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA.
²Division of Cardiovascular Surgery, Yamato Seiwa Hospital, Yamato, Japan.

DOI: 10.4236/wjcs.2015.512021                

Abstract

A 64-year-old woman presented to our facility with recurrent chest tightness. Angiography showed a dilated (10 mm) aneurysmal tortuous coronary artery fistula (CAF) to the main pulmonary arterial trunk occupying a large area of the anterior surface of the aortic root. Left and right heart catheterization showed high left-to-right shunt flow. Fissurectomy and coronary artery bypass grafting were performed. The patient had no postoperative complications and became asymptomatic. The outcome of our case shows that CAF should be a differential diagnosis of recurrent symptomatic cardiac ischemia. Intervention is indicated if symptoms or secondary complications develop.

Keywords

Congenital, Coronary Aneurysm, Coronary Fistula, Angina

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Kwon, S.H., Oh, J.H., Hwang, S.J., Kim, S.J., Kim, M.G., et al. (2010) Bilateral Coronary Artery Fistulae to Main Pulmonary Discovered Incidentally upon Multidetector-Row Computed Tomography. Texas Heart Institute Journal, 37, 127-128.
[2]	Guedes, M.A., Riso Ade, A., BarberoMarcial, M. and Stolf, N.A. (2009) Off-Pump Correction of Coronary Fistula: The Single Suture Technique Approach. Revista Brasileira de Cirurgia Cardiovascular, 24, 581-583. http://dx.doi.org/10.1590/S0102-76382009000500023
[3]	Jama, A., Barsoum, M., Bjarnason, H., Holmes, D.R. and Rihal, C.S. (2011) Percutaneous Closure of Congenital Coronary Artery Fistulae. JACC: Cardiovascular Interventions, 4, 814-821. http://dx.doi.org/10.1016/j.jcin.2011.03.014
[4]	Szalat, A., Durst, R., Cohen, A. and Lotan, C. (2005) Use of Polytetrafluoroethylene-Covered Stent For Treatment of Coronary Artery Aneurysm. Catheterization and Cardiovascular Interventions, 66, 203-218. http://dx.doi.org/10.1002/ccd.20448
[5]	Angelini, P. (2002) Coronary Artery Anomalies Current Clinical Issues: Definitions, Classification, Incidence, Clinical Relevance, and Treatment Guidelines. Texas Heart Institute Journal, 29, 271-278.
[6]	McMahon, C.J., Nihill, M.R., Kovalchin, J.P., Mullins, C.E. and Grifka, R.G. (2001) Coronary Artery Fistula. Management and Intermediate Term Outcome after Transcatheter Coil Occlusion. Texas Heart Institute Journal, 28, 21-25.
[7]	Kamiya, H., Yasuda, T., Nagamine, H., Sakakibara, N., Nishida, S., et al. (2002) Surgical Treatment of Congenital Coronary Artery Fistulas: 27 Years’ Experience and a Review of the Literature. Journal of Cardiac Surgery, 17, 173- 177. http://dx.doi.org/10.1111/j.1540-8191.2002.tb01195.x