Dual Coronary Artery Fistula from Left Anterior Descending and Right Coronary Artery to Pulmonary Trunk in a Patient with Myocardial Infarction—A Case Report
Coronary artery fistulas (CAF) are precapillary communications between a coronary artery and a cardiac chamber or vessel. CAF have been described as the most common hemodynamically significant congenital coronary anomal. However, it remains a relatively uncommon clinical problem. Coronary fistulas originates slightly more common from the right than from the left coronary artery, but the bilateral fistulas—those that originate from both coronary arteries—accounts for only 5% of total cases. These bilateral fistulas have a unique tendency to terminate in the pulmonary artery. More than half of the bilateral and only 17% of unilateral fistulas, terminates in this manner [1]. CAF are believed to be embryological remnants of sinusoidal connections between the lumens of the primitive tubular heart. This was first described by Maude Abbott in 1908 [2]. These fistulas are usually discovered incidentally upon coronary angiography [3]. Their incidence in the overall population is reported about 0.002% and constitutes 0.13% of congenital cardiac lesion, however, they are found in 0.05% to 0.25% of patients who undergo coronary angiography. The most common site of drainage is the right ventricle seen in 41% of patients. Congenital CAFs usually result from abnormal embryological development of the myocardial vascular system. Acquired CAFs are seen after trauma, endovascular procedures like coronary angiography, endomyocardial biopsy etcor cardiac transplantation. True fistulas of the circulatory system are characterized by an ectatic vascular segment that shows aberrant flow connecting two vascular territories governed by large pressure differences. We report a case of double coronary to pulmonary artery fistula discovered during emergent coronary angiography for acute inferior wall ST-elevation myocardial infarction (STEMI) in a patient with no prior cardiac symptoms.
Cite this paper
Mishra, A. , Ete, T. , Dorjee, R. , Jha, P. K. , Malviya, A. and Kavi, G. (2016). Dual Coronary Artery Fistula from Left Anterior Descending and Right Coronary Artery to Pulmonary Trunk in a Patient with Myocardial Infarction—A Case Report. Open Access Library Journal, 3, e2590. doi: http://dx.doi.org/10.4236/oalib.1102590.
Jerbi, S.,
Tarmiz, A.,
Fradi, S., et al. (2009)
Coronary Artery Fistula: Case Report and Review of the Literature. Annales de Cardiologie et d Angéiologie (Paris), 58, 236-239. http://dx.doi.org/10.1016/j.ancard.2008.05.014
Lerberg, D.B.,
Ogden, J.A.,
Zuberbuhler, J.R. and Bahnson, H.T. (1979) Anomalous Origin of the Right Coronary Artery from the Pulmonary Artery. Annals of Thoracic Surgery, 27,
87. http://dx.doi.org/10.1016/S0003-4975(10)62981-5
Parga, J.R.,
Ikari, N.M.,
Bustamante, L.N.,
Rochitte, C.E.,
de Avila, L.F. and Oliveira, S.A. (2004) Case Report: MRI Evaluation of Congenital Coronary Artery Fistulas. The British Journal of Radiology, 77, 508-511. http://dx.doi.org/10.1259/bjr/24835123
Mavroudis, C.,
Backer, C.L.,
Rocchini, A.P.,
Muster, A.J. and Gevitz, M.
(1997) Coronary Artery Fistulas in Infants and Children: A Surgical Review and Discussion
of Coil Embolization. Annals of Thoracic
Surgery, 63, 1235-1242. http://dx.doi.org/10.1016/S0003-4975(97)00251-8
