Congenital Coronary Artery Fistulas: Report of Three Rare Cases

Document Type : Case Report

Abstract

Coronary artery fistula is a rare congenital anomaly with an incidence of about 0.2 - 0.6% in
different reports. It is defined as a direct communication between the coronary artery and any
surrounding cardiac chamber or vascular structure which bypasses the myocardial capillary bed.
Three interesting cases of coronary artery fistula are reported. Two of the patients were
symptomatic. In one case, all coronary arteries (in addition to duplicated LAD) were fistulized into
the right ventricle. Diagnosis was made by echocardiographic study and coronary angiography.
Surgical correction is discussed. In one case, angiography six months later showed no fistula. Serial
echocardiography during follow-up was unremarkable (Iranian Heart Journal 2008; 9 (1):64 -68).

Keywords


1. Swan H, Wilson IN, Woodwark G, Blount SG Jr.
Surgical Obliteration of a coronary artery fistula
to right ventricle. AMA Arch Surg 1959; 79:
820.
2. Daniel TM, Graham TP, Sabiston DC Jr.
Coronary artery- right ventricular fistula with
congestive heart failure: Surgical correction in
the neonatal period. Surgery 1970; 67: 985.
3. Gillbert C, Van Hoof R, Van de Werf F, Piessens
J, De Geest M. Coronary artery fistula in an
adult population. Europe Heart J 1986; 7: 437-
43.
4. Oldham HN Jr, Ebert PA, Young WG, Sabiston
DC Jr. Surgical management of congenital
coronary artery fistula. Ann Thorac Surg 1971;
12: 503.
5. Rittenhouse EA, Doty DB, Ehrenhaft Jl.
Congenital coronary artery- cardiac chamber
fistula. Ann Thorac Surg 1975; 20: 468.
6. Baim DS, Kline H, Silverman Jf. Bilateral
coronary artery- pulmonary artery fistulas
.Report of five cases and review of the literature.
Circulation 1982; 65: 810.
7. Liberthson RP, Sagar K, Berkoben JP, Weintraub
RM, Levine FH. Congenital coronary
arteriovenous fistula: Report of 13 patients.
Review of literature and delineation of
management. Circulation 1979; 59: 849- 54.
8. Choh S, Orime Y, Tsukamoto S, Shiono M,
Neghishi N. Successful surgical treatment of
rupture of coronary arteriovenous fistula with
unconsciousness after chest and back pain. Ann
Thorac cardiovasc surg 2005 Jun; 11(3): 190- 3.
9. Kamiya H, Yasuda T, Nagamine H. Sakakibara
N, Nishida S, Kawasuji M, Watanabe G.
Surgical treatment of congenital coronary artery
fistulas: 27 years experience and a review of the
literature. J card Surg. 2002 Mar- Apr; 17 (2):
173- 7.
10. Hara H, Morio M, Araki T, Kunimasa T, Tsunoda
T, Suzuki M, Sugi K, Nakamura M. Coronary
artery fistula with an associated aneurysm
detected by 16- slice multidetector row
computed tomographic angiography. Heart
Vessels. 2005 Jul; 20 (4): 184- 5.
11. Dahiya R, Copeland J, Butman SM, Myocardial
ischemia and congestive heart failure from a left
main to coronary sinus fistula. Cardiol Rev 2004
Jun- Feb; 12 (1): 59- 62.
12. Hsieh KS, Huang TC, Lee CL. Coronary artery
fistulas in neonates, infants, and children:
Clinical findings and out come. Pediator cardial
2002 Jul- Aug; 23 (4): 415- 9.
13. Misra P, Tandon N. Coronary artery fistula: Case
report and review of literature. Ann Heart Hosp
J. 2003 summer; 1 (3): 252- 4.
14. Atmaca Y, Altin T, Ozdol C, Pamir G, Caglar N,
Oral D. Coronary- pulmonary artery fistula
associated with right heart failure: Successful
closure of fistula with a graft stent. Angiology.
2002 Sep- Oct; 53 (5): 613-6.
15. Iida R, Ymamoto T, Suzuki T, Saeki S, OgawaS.
The usefulness of intraoperative transesophageal
echocardiography to identify the site of drainage
of coronary artery fistula .
16. David L.C. Cheug, Wing- kuk Au, Henry H.C.
Cheung, Dement S.W. Chiu, Wai- Tsun Lee.
Coronary artery fistulas: Long- term results of
surgical correction. Ann Thorac Surg 2001; 71:
190- 5.