Case Report
Am Heart Hosp J. 2011;9(2):116–8
Late-term Post-operative Recanalization of a Fistula between the Coronary Artery and Bronchial Vein
Ömer Şatıroğlu, MD, Turan Erdoğan, MD, Mehmet Bostan, MD, Yüksel Çiçek, MD and Ahmet Temiz, MD
A coronary artery fistula is a rare congenital anomaly that creates a direct link between the coronary artery and the heart chambers or other vascular structures. It is often identified coincidentally during diagnostic coronary angiography and may cause coronary steal syndrome. We report on a 54-year-old man with myocardial ischemia who had coronary angiography and a recanalized fistula was detected during the procedure.
oronary artery fistulas (CAFs) are abnormal links between epicardial coronary arteries and other cardiac chambers, large veins or other vascular structures. Most CAFs are small and are identified coincidentally during coronary angiography. However, large fistulas can cause myocardial ischemia and angina due to coronary steal syndrome. CAFs may cause several cardiac problems such as acute myocardial infarction, sudden cardiac death, congestive heart failure, endocarditis, stroke, arrhythmia, and coronary aneurysm rupture. CAFs were found at a frequency of 0.18 % in a series of 33,000 patients who had coronary angiography.1 In a Turkish series, this frequency was found to be approximately 0.08 %.2
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We present a case report on a man with a CAF that caused myocardial ischemia between the coronary artery and the bronchial vein which was surgically ligated five years ago and recanalized in the late term. It has not been reported in the literature so far.
Case
A 54-year-old man presented to our clinic with chest pain upon exertion. The patient had hypertension and non-insulin-dependent diabetes mellitus. He had
coronary angiography five years ago because of angina pectoris. The coronary angiography was normal but a congenital CAF between the right coronary artery (RCA) and the bronchial vein was found. It was surgically closed because it was causing ischemia. The fistula between the RCA and the bronchial vein was isolated parallel to the non-coronary sinus annulus of the aorta and the right atrium chamber. The fistula was tied off with nylon double tape and closed with the placement of a 5/0 transfixion suture in the center. The patient was discharged with a stable condition. During examination, electrocardiography was normal but the exercise test was positive. Echocardiography revealed normal left ventricle systolic function, and slight dilation (4.2 cm) of the aortic root. Coronary angiography was performed due to the patient’s increasing complaints. Coronary angiography revealed normal coronary arteries, and a fistula between the RCA and the bronchial vein (Figures 1–3). Due to the patient's symptoms recurring, we thought that the fistula may have reopened and be causing myocardial ischemia (Figure 4). Closure of the fistula using catheter-based methods (transcatheter coil embolization) was planned. The patient was discharged under medical treatment, and was given an appointment for the procedure.
• Department of Cardiology, School of Medicine, Rize University, Rize • Correspondence: Omer Satiroglu, MD, Rize Üniversitesi Tıp Fakültesi, Kardiyoloji bölümü, 53100 Rize, Turkey. E:
omersatiroglu@yahoo.com
116 Late-term Post-operative Recanalization of a Fistula between the Coronary Artery and Bronchial Vein Winter 2011
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