Congenital coronary-pulmonary artery fistula originating from right and left coronary artery

Year 2013, Volume: 40 Issue: 4, 659 - 662, 01.12.2013

Ali Kemal Gür Ahmet Karakurt Yüksel Kaya

https://doi.org/10.5798/diclemedj.0921.2013.04.0352

Cited By: 1

Abstract

Coronary artery fistula (CAF) is a rare congenital anomaly with an incidence of 1 in 50 000 live births. The fistula was observed at the right coronary artery in 53%, the left coronary artery in 42% and both coronary artery in 5% of the cases. Echocardiography examination in a 46 year-old woman with the symptoms of chest pain, palpitation and dyspnea revealed a severe mitral valve insufficiency and a moderate to severe tricuspid valve insufficiency. A CAF originating from the proximal part of the left anterior descending artery (LAD) and another fistula originating from osteal part of the right coronary artery (RCA) were detected by coronary angiography. Both fistulas were draining into the main pulmonary artery. The coronary artery fistula closed under cardiopulmonary by-pass. Mitral insufficiency originated from the posterior leaflet was diagnosed intra-operative exploration, and thereafter it was repaired with mitral annuloplasty including a quadrangular resection and use of a 32 No St Jude mitral ring. Tricuspid valve was repaired with Calangos Ring annuloplasty. Following six day hospital stay, the woman was discharged free of any symptom.

Keywords

Dyspnea, double arteriovenous fistula, mitral and tricuspid insufficiency

Konjenital sağ ve sol koroner arter kaynaklı koroner-pulmoner arter fistülü

Abstract

Koroner arter fistülü (CAF) , 50 000 canlı doğumda 1 görülen, nadir konjenital anomalidir. Fistül, vakaların %53 oranında sağ koroner arterde, %42 oranında sol koroner arterde ve %5 oranında iki koroner arterde görülmektedir. Göğüs ağrısı, çarpıntı ve nefes darlığı semptomlu 46 yaşında bayan hastanın ekokardiyografik muayenesinde, ileri mitral yetersizliği ve orta-ileri triküspid yetersizliği tespit edildi. Koroner anjiyografide, biri left anterior descending arter (LAD) proksimalinden ve diğeri right coronary artery (RCA) ostealinden kaynaklanan CAF tespit edildi. Her iki fistülde ana pulmoner artere drene olmaktaydı. CAF kardiyopulmoner bypass altında kapatıldı. İntra-operatif eksplorasyonda mitral kapaktaki yetersizliğin posterior leaflete ait olduğunu tespit edildi ve sonrasında quadrianguler rezeksiyon ve 32 No St Jude mitral halka kullanarak mitral annuloplasty yapıldı. Triküspid kapak Calangos Ring annuloplasty yapılarak tamir edildi. Her hangi bir semptomu olmayan hasta, altı gün hastanede takip edildikten sonra taburcu edildi.

Keywords

Dispne, çift arteriyovenöz fistül, mitral ve triküspit yetmezliği

References

• Baim DS, Kline H, Silverman JF. Bilateral coronary artery- -pulmonary artery fistulas. Report of five cases and review of the literature. Circulation 1982;65:810-815.
• Dahida R, Copeland J, Butman SM. Myocardial ischemia and congestive heart failure from a left main to coronary sinus fistula. Cardiol Rev 2004;12:59-62.
• Schumacher G, Roithmaier A, Lorenz HP, et al. Congeni- tal coronary artery fistula in infancy and childhood: diag- nostic and therapeutic aspects. Thorac Cardiovasc Surg 1997;45:287-294.
• Elsayed H, Govindraj R, El-Dean I, et al. Acute coronary syndrome due to coronary artery-pulmonary artery fistula. Asian Cardiovasc Thorac Ann 2011;19:284.
• Alkhulaifi AM, Horner SM, Pugsley WB, et al. Coronary artery fistulas presenting with bacterial endocarditis. Ann Thorac Surg 1995;60:202-204.
• Reidy JF, Sowton E, Ross DN. Transcatheter occlusion of coronary to bronchial anastomosis by detachable balloon combined with coronary angioplasty at same procedure. Br Heart J 1983;49:284-287.
• De Santis A, Cifarelli A, Violini R. Transcatheter closure of coronary artery fistula using the new Amplatzer vascular plug and a telescoping catheter technique. J Cardiovasc Med 2010;11:605-609.
• Karabulut H, Toraman F, Alhan C, et al. Konjenital bilateral koroner-pulmoner arter fistülü. TGKDCD 1999;7:495-496.
• Dimitrakakis G, Otto von Oppell U. Surgical treatment of coronary arteriovenous fistulas. Interact Cardiovasc Thorac Surg 2011;13:674-675.