Diagnostic and Management Approach of Patients with Coronary Artery Fistula: Case Series

Author : N.I. Gayatri, O. Lilyasari, P.S. Roebiono, A.U. Rahayoe, I. Sakijan, R. Prakoso, Y. Kurniawati, G.M.
Upload Date : 19-04-2018

Background: Coronary artery fistula (CAF) is an anomalous connection between one or more coronary artery and a major vessel or cardiac chamber. Most of the coronary fistulas are discovered incidentally during angiographic evaluation or echocardiograhy. The management of CAF is complicated and recommendations are based on very small retrospective reviews. We report a case series of four CAF cases with different anatomic morphology and to discuss the choiced diagnostic modalities and management of them.

Case illustration: The first patient was 5 month old male with asymptomatic CAF, had continous murmur as sign of CAF. The transthoracic echocardiography (TTE) found medium sized fistula originated from LCA and drainage to right ventricle (RV) apex. Percutaneous embolization has attempted but canceled due to difficulty of fistula cannulation. The second patient was 29 year old female with dyspnea on exertion and continous murmur. TTE and MSCT found a big tortuous fistula originated from right coronary artery (RCA) and drainage to right atrium. The patient performed unsuccesfull device closure because the fistula was too big. Then, they underwent surgical ligation with good result and without residual symptom or shunt.

The third patient was 4 year old female with exercise intolerance as symptom and continous murmur found at physical examination. The TTE and MSCT revealed big tortuous fistula with dilatation of RCA and drainage to mid RV. The fourth patient was 12 year old male with dyspnea on exertion and murmur. TTE and MSCT  found big fistula from LCA to RV. Successful transcatheter closure using duct occluder was performed in both patient.

Summary: Diagnosis of CAF could be considered when continuous murmur was heard over area unusual for the patent ductus arteriosus. There is no ideal management consensus for coronary artery fistula. However, intervention are often chosen since the serious complications can occur.

KEYWORDS : Coronary artery fistulas, Congenital heart disease, Surgical intervention, Percutaneous intervention.

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