Coronary Artery Fistula within Large Left Atrial Thrombus in a Patient with Rheumatic Mitral Stenosis: A Case Report and Review

Abstract

Coronary artery fistulae, which are connections between coronary artery branches and cardiac chambers or major vessels, are usually congenital forms of coronary artery anomalies, but rarely may be acquired because of cardiac trauma, neovascularity in association with cardiac neoplasm, mural thrombus formation, or iatrogenic causes. Although half of the patients with coronary artery fistula remain asymptomatic, these fistulae may lead to angina, syncope, congestive heart failure, myocardial infarction, and sudden death. Here we present a case of coronary artery fistula between right coronary artery and left atrium through a large left atrial thrombus in a patient with rheumatic mitral stenosis. The diagnosis was confirmed using echocardiography, conventional and multislice computed tomography, and coronary angiography. To the best of our knowledge, this interesting and unique entity is the first to be reported in the present literature.

Keywords

• Coronary artery fistula,left atrial thrombus,rheumatic mitral stenosis

Romatizmal Mitral Stenozu Olan Hastada Büyük Sol Atriyal Trombüs İçine Doğru Seyreden Koroner Arter Fistülü

Abstract

Koroner arter dalları ile kardiyak boşluklar veya büyük damarlar arasındaki normal dışı bağlantılar olan koroner arter fistülleri (KAF) genellikle koroner arter anomalilerinin konjenital formlarıdır. Fakat nadiren kardiyak travma, iyatrojenik nedenler veya kardiyak neoplazm ve mural trombüs oluşumu ile ilişkili neovaskülarizasyona ikincil edinsel olabilir. KAF’ı olan hastaların yaklaşık yarısının asemptomatik kalmasına rağmen bu fistüller anjina, senkop, konjestif kalp yetmezliği, miyokart infarktüsü ve ani ölüme yol açabilirler. Bu yazıda romatizmal mitral kapak stenozu olan bir hastada sağ koroner arter (RCA) ile sol atriyum (LA) arasında, büyük LA trombüs içine açılan KAF’ı sunuyoruz. Tanı 2 boyutlu ekokardiyografi, konvansiyonel koroner anjiyografi ve çok kesitli bilgisayarlı tomografik koroner anjiyografi kullanılarak doğrulandı. Bildiğimiz kadarı ile bu ilginç ve benzersiz durum mevcut literatürde ilk defa raporlanmıştır.

Keywords

• Koroner arter fistülü,sol atriyal trombüs,romatizmal mitral kapak darlığı

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