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This article, published in the journal Pediatric Anesthesia, presents a case report of an infant with a congenital coronary artery anomaly. The patient initially presented with symptoms of heart failure and was diagnosed with anomalous left coronary artery from pulmonary artery (ALCAPA) based on preoperative investigations. However, during intraoperative transesophageal echocardiography (TOE) and surgical inspection, the diagnosis was changed to a normal left coronary artery with a coronary arteriovenous fistula between the left main stem coronary artery and pulmonary artery. The article emphasizes the importance of intraoperative echocardiography in confirming diagnoses and improving patient outcomes. [Extracted from the article]

Summary: Coronary arteriovenous fistulas are an abnormal conduit between a coronary artery and another cardiovascular lumen, without an intervening capillary bed. The reported prevalence is 0.002–0.3%. Physiologic consequences such as congestive heart failure, coronary steal phenomenon and fistula aneurysm formation and rupture are possible. There are limited reports of symptomatic coronary arteriovenous fistulas in association with pregnancy. We describe a 19‐year‐old woman with symptomatic left circumflex artery to coronary sinus fistula, terminating into a large exophytic varix in the right atrium, presenting for an elective caesarean section at 37 weeks gestational age. Our anaesthetic management strategy aimed to optimise myocardial perfusion, maintain euvolemia, avoid right ventricular obstruction from exophytic varix and avoid sympathetic stimulation or sudden increases in pulmonary vascular resistance. A slowly titrated epidural was used as the primary anaesthetic. Our patient tolerated the procedure well and was discharged home on postoperative day two. Understanding of the potential physiologic consequence of coronary arteriovenous fistulas, and interaction with the physiologic changes of pregnancy and delivery, are essential for the management of these cases. [ABSTRACT FROM AUTHOR]

Coronary arteriovenous fistulas are rare coronary anomalies. Most fistulas arise from the right coronary artery and drain into the right heart structures. We report a case of a 59-year-old man with a rare coronary arteriovenous fistula that originates from the left coronary artery and drains into the superior vena cava. He was diagnosed incidentally with cardiac computed tomography during the investigation for atrial fibrillation. Surgical fistula ligation was successfully performed under cardiac arrest with cardiopulmonary bypass. The patient was discharged without complications. [ABSTRACT FROM AUTHOR]

A 54-year-old, asymptomatic, disease-free female patient was operated for an incidentally detected left main coronary artery aneurysm (CAA) associated with fistula to a giant aneurysm associated with the right atrium (RA). The patient had an extremely rare left main CAA and a fistula connection of a giant aneurysm connecting to the RA.

The existence of an anomalous connection between any of the cardiac chambers and a major coronary artery is the characteristic feature of coronary cameral fistula. This is a case of an 8-year-old child with a congenital coronary cameral fistula from the left circumflex to the right atrium. The fistula was surgically ligated. The postoperative course was uneventful with a good outcome. [ABSTRACT FROM AUTHOR]

Coronary arteriovenous fistula (CVAF) is usually an asymptomatic, incidental finding observed in 0.1%–0.2% of patients undergoing coronary angiography. Myocardial infarction (MI) secondary to a CVAF has been rarely reported. We herein describe a case of a young male presenting with acute inferior wall MI without any underlying cardiovascular risk factors and normal coronaries except for the presence of a small CVAF arising from the proximal right coronary artery. This report deliberates on the possibility of this fistula being an incidental finding as a bystander or as a culprit in this special clinical scenario, after careful exclusion of other possible nonatherosclerotic etiologies.

A 54-year-old, asymptomatic, disease-free female patient was operated for an incidentally detected left main coronary artery aneurysm (CAA) associated with fistula to a giant aneurysm associated with the right atrium (RA). The patient had an extremely rare left main CAA and a fistula connection of a giant aneurysm connecting to the RA. [ABSTRACT FROM AUTHOR]

Background and Aim of the Study: Coronary artery fistula (CAF) is a relatively rare cardiac anomaly. We investigated long‐term outcomes following surgical repair of CAF in adults. Methods: We retrospectively investigated 13 consecutive patients undergoing surgical repair of CAF in our institution between 2008 and 2019 (67.3 ± 10.4 years old, 38% male). CAF types were coronary artery‐pulmonary artery fistula (77%), coronary artery‐coronary sinus fistula (15%), and both (8%). CAFs originated from the left coronary artery (38%), right coronary artery (8%), and bilateral coronary arteries (38%). Pulmonary and systemic flow (Qp/Qs) was measured in seven patients (54%), with a mean value of 1.52. Seven patients underwent surgery for CAFs alone, and others simultaneously underwent surgery for comorbid cardiac diseases. Results: All procedures were conducted under cardiopulmonary bypass. Surgical procedures were direct epicardial ligation of fistula (92%), direct closure of CAF through pulmonary artery incision (38%), direct closure of CAF through coronary sinus incision (8%), or patch closure of CAF through coronary artery incision (8%). Myocardial perfusion scintigraphy showed asymptomatic myocardial ischemia in the right coronary area after surgery in one patient. There were no deaths perioperatively or during follow‐up (mean: 66.6 months). There were no coronary or other CAF‐related events. Conclusions: Several anatomical variations in CAF were observed which coexist with cardiac disease. Long‐term outcomes following surgical repair were satisfactory, and the concurrent intervention of CAFs during surgery for comorbid cardiac disease is useful to prevent future complications related CAFs in adults. [ABSTRACT FROM AUTHOR]

Coronary to pulmonary artery fistula is a rare form of congenital coronary artery anomaly. Majority of coronary arteriovenous fistula detected incidentally on coronary angiography. Although, most of these patients are asymptomatic, larger fistulae can produce symptoms of heart failure. Here we present a rare case of 61-year-old female who presented primarily for mitral valve replacement for severe mitral stenosis. On screening angiography, there were two fistula arising from both right and left coronary artery and draining in to the main pulmonary artery. The patient was operated and mitral valve replacement with closure of the fistula. Patient had an uneventful post-operative period and was discharged on 7 the post-operative day.

Coronary-pulmonary artery fistulas are rare congenital or acquired anomalies of the coronary artery that may originate from any of the three major coronary arteries and drain into the right-sided cardiac chambers and or large vessels draining into the pulmonary circulation. A triple combination of ventricular tachycardia, rheumatic heart disease, and bilateral coronary pulmonary fistula is a rare association. A rare combination of observations was detected in a single patient with three distinct etiopathogenesis that is not described in the literature.

Abstract Background Coronary artery aneurysm (CAA) is defined as dilatation exceeding 1.5 times the width of the normal adjacent coronary artery segments. CAA usually causes few symptoms, and rupture is rare, but can be lethal due to cardiac tamponade when it does occur. Case presentation A 79-year-old woman presented with presyncope and back pain. Emergency surgery was performed based on a diagnosis of cardiac tamponade due to either rupture of coronary arteriovenous fistula or CAA. At surgery, a rupture site was located on the wall of the giant CAA, with a diameter of 55 mm, originating from the ostium of the right coronary artery. Suture closure of the inflow and outflow of the aneurysm was performed, and the aneurysmal cavity was obliterated by multiple sutures. The patient made an uneventful recovery and was discharged from hospital on postoperative day 13. Conclusion On the basis of this case, we propose considering rupture of a CAA as one of the causes of cardiac tamponade.

Background: Current guidelines on coronary anomalies are primarily based on expert consensus and a limited number of trials. A gold standard for diagnosis and a consensus on the treatment strategy in this patient group are lacking, especially for patients with an anomalous origin of a coronary artery from the opposite sinus of Valsalva (ACAOS) with an interarterial course. Aim: To provide evidence-substantiated recommendations for diagnostic work-up, treatment and follow-up of patients with anomalous coronary arteries. Methods: A clinical care pathway for patients with ACAOS was established by six Dutch centres. Prospectively included patients undergo work-up according to protocol using computed tomography (CT) angiography, ischaemia detection, echocardiography and coronary angiography with intracoronary measurements to assess anatomical and physiological characteristics of the ACAOS. Surgical and functional follow-up results are evaluated by CT angiography, ischaemia detection and a quality-of-life questionnaire. Patient inclusion for the first multicentre study on coronary anomalies in the Netherlands started in 2020 and will continue for at least 3 years with a minimum of 2 years of follow-up. For patients with a right or left coronary artery originating from the pulmonary artery and coronary arteriovenous fistulas a registry is maintained. Results: Primary outcomes are: (cardiac) death, myocardial ischaemia attributable to the ACAOS, re-intervention after surgery and intervention after initially conservative treatment. The influence of work-up examinations on treatment choice is also evaluated. Conclusions: Structural evidence for the appropriate management of patients with coronary anomalies, especially (interarterial) ACAOS, is lacking. By means of a structured care pathway in a multicentre setting, we aim to provide an evidence-based strategy for the diagnostic evaluation and treatment of this patient group. [ABSTRACT FROM AUTHOR]

An anomalous coronary artery is reported in 2% to 23% of patients with tetralogy of Fallot (TOF). Knowledge of coronary anatomy prior to corrective surgery is vital to avoid damage to vessels crossing the right ventricular outflow tract (RVOT). A meta-analysis on the prevalence of anomalous coronary arteries in TOF is lacking to date. Here, an overview of coronary anomalies in TOF is provided and implications for patient management are discussed. PubMed, Embase and Web of Science were searched. Analysis was done using Revman 5.3 (Cochrane Community, London). The primary analysis focused on the origin and proximal course of the right and left coronary arteries. In addition, the prevalence of large conus arteries and coronary arteriovenous fistulas (CAVF) was calculated. Twenty-eight studies, encompassing 6956 patients, were included; 6% of TOF patients have an anomalous coronary artery. Hereof, 72% cross the RVOT; the majority of the remaining 28% courses behind the aorta. Six percent of patients have a large conus artery and 4% a CAVF. Other coronary anomalies include a left or right coronary artery from the pulmonary trunk or left or right pulmonary artery, coronary tree hypoplasia and anastomoses between coronary and bronchial arteries. The prevalence of coronary anomalies in TOF is 4–6%. In patients with an anomalous coronary artery, 72% cross the RVOT. The combined risk of encountering an anomalous coronary artery or a large conus artery crossing the RVOT is 10.3%. Coronary anatomy should be defined before surgery and the surgical approach adapted accordingly. Unlabelled Image • The prevalence of coronary anomalies in TOF is 4–6%. • In patients with an ACA, 72% of the anomalous arteries cross the RVOT. • The risk of encountering an ACA or large conus artery crossing the RVOT is 10.3%. • Before surgery, define the coronary anatomy to avoid damage of anomalous vessel. • Surgical approach should be adapted to the course of an anomalous coronary artery. [ABSTRACT FROM AUTHOR]

Coronary to pulmonary artery fistula is a rare form of congenital coronary artery anomaly. Majority of coronary arteriovenous fistula detected incidentally on coronary angiography. Although, most of these patients are asymptomatic, larger fistulae can produce symptoms of heart failure. Here we present a rare case of 61-year-old female who presented primarily for mitral valve replacement for severe mitral stenosis. On screening angiography, there were two fistula arising from both right and left coronary artery and draining in to the main pulmonary artery. The patient was operated and mitral valve replacement with closure of the fistula. Patient had an uneventful post-operative period and was discharged on 7 the post-operative day. [ABSTRACT FROM AUTHOR]

Congenital coronary arteriovenous fistula (CAVF) is a rare and its incidence during coronary angiogram is estimated about 0.1% to 0.2%. In 1908 Maude Abbott described the first CAVF. Majority of coronary artery fistulas are identified during echocardiography or coronary arteriography. They are usually small and clinically difficult to detect. Most of them resolve spontaneously and does not cause any symptoms. A large coronary fistula is usually 3 times bigger the size of a coronary artery. We report a case of congenital arteriovenous fistula arising from left circumflex artery communicating to one of the branches of right pulmonary artery, having normal coronaries. This 77-year-old female with positive stress myoview & multiple risk factors, presented with paroxysmal atrial fibrillation. Asymptomatic CAVF up to the 7th decade of life makes this case rare and unique.

Background: Coronary arteriovenous fistulas (CAVFs) are direct connections from one or more coronary arteries to cardiac chambers or a large vessel. They are mostly of congenital origin. The aim of this study was to describe clinical presentation and also delineate the course and management of CAVF. Methods: Clinical data, chest x-rays, echocardiographic and angiographic evaluation of 40 patients with congenital CAVF during 1990 to 2008 were reviewed retrospectively. Results: Seventeen patients were ≤ 20 years old (42.5%) were mostly asymptomatic, and twenty tree cases were older than 20 years old (57.5%), mostly symptomatic (P

We report the use of intraoperative fluorescence imaging to assist in the surgical management of proximal coronary arteriovenous fistulas in four patients. [ABSTRACT FROM AUTHOR]

BACKGROUND: Coronary arteriovenous fistula is a rare congenital or acquired abnormal connection between a coronary artery and any of the great vessels or any of the heart chambers. Most of them are diagnosed during routine coronary angiography. CASE REPORT: This case report illustrates a successful surgical ligating of multiple right coronary artery and circumflex artery fistulas to coronary sinus. CONCLUSION: According to our experience and literature review, it can be concluded that to prevent potential complications in various cases of coronary arteriovenous fistula, early surgical management, just after their condition has been diagnosed, is the best choice

We report a case of surgical treatment of a 58-year-old symptomatic patient with large coronary artery fistula, which drained from the left anterior descending artery into the main pulmonary artery (PA), and concomitant large patent foramen ovale. The surgery was performed through a median sternotomy with aortobicaval total cardiopulmonary bypass. The PA was incised. The fistula was identified 5 mm above the anterior leaflet of the pulmonary valve and was closed off using a prolene suture. Afterward, the atrium septum defect was closed with a Dacron patch via the standard right atrium access. There were no postoperative complications. [ABSTRACT FROM AUTHOR]

Fístulas das artérias coronárias têm incidência baixa entre as cardiopatias congênitas, muitas vezes assintomáticas, devendo ser suspeitadas quando há presença de sopro contínuo no precórdio. Podem apresentar sintomas de precordialgia ou insuficiência cardíaca e devem ser estudadas adequadamente para tratamento seguro, tanto cirúrgico como por cateterismo ou acompanhamento clínico. No presente trabalho são relatados três casos tratados por operação com resultado satisfatório e a literatura é revisada.Coronary arteries fistulas have low incidence on the congenital heart defects, many times they are assymptomatic, and have to be suspected when continuous cardiac murmur is present. The symptoms can be precordial pain or cardiac failure and they must be studied correctly to a save surgical management or clinic treatment. In this paper are related three cases surgically treated with good results and literature review.

A coronary arteriovenous fistula is an abnormal connection between a coronary artery and any of four chambers in the heart. We repot a unique case with a fistulae originating from right coronary artery and draining into the right atrium via coronary sinus although Takotsubo-like left ventricular dysfunction or acute myocardial infarction was initially thought to have occurred according to the electrocardiogram finding. [ABSTRACT FROM AUTHOR]

A 77-year-old patient suffering from a giant right coronary artery aneurysm with coronary arteriovenous fistula was admitted to our hospital. The fistula could not be documented preoperatively by computed tomography or coronary angiography but was documented intraoperatively by transesophageal echocardiography (TEE). However, TEE was unable to visualize the draining site of the fistula. Direct palpation by the surgeon ultimately confirmed that the fistula was draining into the coronary sinus. The fistula was closed and the volume of the aneurysm reduced by partial resection. The postoperative course of the patient was uneventful. Giant aneurysms occasionally displace cardiac structures. In such cases, combined imaging technologies, including TEE, may be needed for precise assessment of the giant aneurysm and fistula. [ABSTRACT FROM AUTHOR]

Summary: We report the case of a patient with bilateral coronary arteriovenous fistulas (CAVFs) connecting the right coronary artery and left circumflex coronary artery with the right atrium who had progression of first-degree atrioventricular (AV) block to complete AV block during a 4-year period. The His bundle electrogram revealed that the complete AV block was the result of a block at the level of the AV node. Dipyridamole stress thallium-201 myocardial imaging showed decreased perfusion in the inferoapical wall. Coronary angiography and computed tomography showed fistulas that arose from the AV nodal branch of the right coronary artery and from the distal portion of the circumflex coronary artery and drained into the right atrium. Because the fistulas were small, they were not repaired surgically, and a permanent pacemaker was implanted to treat the complete AV block. We presumed that the complication by complete AV block was due to abnormalities of the arteries feeding the AV node and chronic ischemia resulting from a coronary steal associated with the fistulas. To the best of our knowledge, this is the first report of CAVF complicated by complete AV block. [Copyright &y& Elsevier]

BACKGROUND: Coronary arteriovenous fistula is a rare congenital or acquired abnormal connection between a coronary artery and any of the great vessels or any of the heart chambers. Most of them are diagnosed during routine coronary angiography. CASE REPORT: This case report illustrates a successful surgical ligating of multiple right coronary artery and circumflex artery fistulas to coronary sinus. CONCLUSION: According to our experience and literature review, it can be concluded that to prevent potential complications in various cases of coronary arteriovenous fistula, early surgical management, just after their condition has been diagnosed, is the best choice. [ABSTRACT FROM AUTHOR]

Purpose: Four pediatric patients with congenital coronary arteriovenous fistula (CAVF) were reported to remind pediatric practitioners and cardiologists of its diagnosis and management. Materials and Methods: Four pediatric patients with congenital CAVF from June 1999 to November 2007 were included in this retrospective study. Study modalities included reviews of patients' profiles of clinical features, chest radiograph, Doppler echocardiography, cardiac catheterization with angiography, myocardial perfusion scan, and computed tomography. Results: All 4 patients were symptomatic. The clinical symptoms and signs were feeding problem, continuous murmur, tachycardia, tachypnea, cardiomegaly, and exertional chest pain. Myocardial enzyme was elevated in 1 patient. Echocardiography showed dilatation of the coronary artery in all 4 patients, and traced down its origin in 3 and drainage in 4. The fistulas originated from the right coronary artery in 2 patients and left coronary artery in 2, and were drained into the right ventricle in 2, right atrium in 1, and pulmonary artery in 1. Single left coronary artery was found in 1 patient. The pulmonary-to-systemic blood flow ratios ranged from 1.2 to 2.5. Transcatheter coil occlusion was successfully performed in 4 patients through a coaxial delivery system. The symptoms and signs of congestive heart failure and myocardial ischemia disappeared after the procedure. Conclusion: Diagnosis of congenital CAVF could be achieved by appreciation of continuous murmur over area unusual for the ductus, and by scrupulous examination of echocardiography as well as angiography of the coronary artery through which coaxial transcatheter coil occlusion could be performed successfully. [ABSTRACT FROM AUTHOR]

Ventricular septal dissection may rarely result from infective endocarditis, myocardial infarction or sinus of Valsalva aneurysm progression. A rare case that developed in a 66-year-old female after mitral valve replacement for severe mitral regurgitation with cordal rupture is presented and discussed. It resulted from a coronary artery fistula, from a septal branch, to a 6 cm wide saccular cystic cavity within the interventricular septum, which was detected by transthoracic echocardiography some months after surgery. Coronary arteries were anatomically normal. Coronary angiography was helpful to clarify the origin of the fistula. Later on the patient developed heart failure and atrial fibrillation, but she refused any further intervention. She has been followed up for more than 7 years and is presently stable on medical therapy. [ABSTRACT FROM PUBLISHER]

During the last eight years a total of nine cases of isolated congenital coronary arteriovenous fistula (CAVF) have been diagnosed at our centre. Age of these patients ranged from 11 days to 22 years (mean 6.4 +/- 4.2 years). There were seven male and two female patients. Right and left coronary arteries were the sites of origin in seven and three cases respectively. One patient had two fistulae, one each originating from right coronary artery and obtuse marginal artery. The drainage sites were right ventricle in seven cases and right atrium in two. The pulmonary artery pressure was normal in eight cases and elevated in one case. The pulmonary artery to systemic flow ratio ranged from 1.1:1-2.4:1 in all except the 11 day-old-baby in whom it was 4:1. Pulmonary vascular resistance (PVRI) was below 3.5 in all cases (range 1.0-3.5 units). Surgical ligation of fistula was done in four cases and two patients underwent coil embolisation of fistula. Follow-up is available in five out of eight patients including three cases in whom CAVF was closed. Two other young patients are being followed-up conservatively and all the patients are asymptomatic. CAVF can present at any age; majority of the cases have small left to right shunts and more commonly CAVF arise from right coronary artery. Surgical ligation of fistula is safe in older patients, non-surgical embolisation using coils may be an alternative to surgery in selected cases. [ABSTRACT FROM AUTHOR]

Coronary arteriovenous fistula are uncommon if not rare, but represent the most prevalent hemodynamically significant congenital malformations of the coronary arterial circulation. The goal of this report is to evaluate the use of 3D volume rendering from transaxial breathhold coronary MR angiograms to visualize coronary arteriovenous fistulas. Coronary MR angiography offers a new non-invasive technique that accurately defines the anatomy of these malformations, setting the stage for surgical intervention. [ABSTRACT FROM AUTHOR]

A case of coronary artery dilatation in childhood, initially attributed to Kawasaki disease, was determined by careful serial echocardiography to be the result of congenital coronary arteriovenous fistulae. [ABSTRACT FROM AUTHOR]