Coronary Artery Fistula, an Unusual Cause of Chest Pain in Adult : Role of Computed Tomography Angiography

  • Prima Almazini Departemen Kardiologi dan Kedokteran Vaskular Fakultas Kedokteran Universitas Indonesia
  • Andy Rahman Departemen Kardiologi dan Kedokteran Vaskular Fakultas Kedokteran Universitas Indonesia
  • Dian Yaniarti Departemen Kardiologi dan Kedokteran Vaskular Fakultas Kedokteran Universitas Indonesia
  • Elen Sahara Departemen Kardiologi dan Kedokteran Vaskular Fakultas Kedokteran Universitas Indonesia
  • Celly Anantaria Departemen Kardiologi dan Kedokteran Vaskular Fakultas Kedokteran Universitas Indonesia
  • Manoefris Kasim Departemen Kardiologi dan Kedokteran Vaskular Fakultas Kedokteran Universitas Indonesia
DOI: https://doi.org/10.30701/ijc.v36i4.504

Abstract

Coronary artery fistula, usually congenital in origin, is an abnormal communication between a coronary artery and a cardiac chamber or great vessel. A coronary artery fistula can produce myocardial ischemia from coronary steal phenomenon. First case, a 54-year-old man was found to have a fistula from the left anterior descending coronary artery and right coronary artery to the main pulmonary artery, a rare anomaly. This patient developed chest pain due to myocardial ischemia in the left anterior descending coronary artery distribution for several months before evaluation. The patient was suggested to close the fistula but rejected. Second case, a-57 year-old woman was found to have fistula from left anterior descending coronary artery to main pulmonary artery. Patient presented with chest pain since 6 years ago. The patient was planned to close the fistula transcutaneously. Coronary artery fistulas, though rare, should be considered in the differential diagnosis when an adult patient presents with chest pain. Although coronary angiography is the gold standar diagnostic test for detection of coronary artery fistula, computed tomography angiography may be an alternative test through its good spatial resolution.

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References

1. Davies S. Clinical presentation and diagnosis of coronary artery disease: stable angina. Br Med Bull. 2001; 59 (1): 17-27. doi: 10.1093/bmb/59.1.17

2. Spektor G, Gehi A, Love B, Sharma S, Fuster V. A case of symptomatic coronary artery fistula. Nature Clin Practice Cardiovasc Med. 2006; 3(12):689-92. Doi:10.1038/ncpcardio0709

3. Warnes C, Bashore T, Dearani J, Graham T, Hunt S, Landzberg M, et al. ACC/AHA guidelines for the management of adults with congenital heart disease. Circulation. 2008;118:e714-e833. Doi: 10.1161/circualtionaha.108.190690

4. Latson L. Coronary artery fistula: how to manage them. Cath Cardiovasc Int. 2007;70:110-16. Doi:10.1002/ccd.21125

5. Ata Y, et al. Coronary arteriovenous fistulas in the adults: natural history and management strategies. J Cardiothoracic Surg. 2009;6:62

6. Liberthson R, Sagar K, Berkoben J, Weintraub R, Levine F. Congenital coronary arteriovenous fistula. Report of 13 patients, review of theliterature and delineation of management. Circulation. 1979;59:849-54

7. Fahey JT, Asnes J. Coronary recanalization due to presumed thrombosis following surgical ligation of a large righ coronary artery to right ventricle fistula. Congenit Heart Dis. 2008;3:295-98

8. Luo et al. Coronary arterial fistulas. Am J Med Sci. 2006;332:70-84

9. Okwuosa TM, Gundeck EL, Ward RP. Coronary to pulmonary artery fistula: diagnosis by transesophageal echocardiography. Echocardiography. 2006;23(1):62-4

10. Qureshi SA. Coronary arterial fistulas. Orphanet J Rare Dis. 2006;1:1-6

11. Krishnamoorthy KM, et al. Transesophagial echocardiography for the diagnosis of coronary arteriovenous fistula. Int J Cardiol. 2004;96(2):281-3

12. Angelini P, et al. Coronary artery anomalies, current clinical issues definitions, classification, incidence, clinical relevance, and treatment guidelines. Tex Heart Inst J. 2002;29:271-78

13. Gowda RM, Vasvada BC, Khan IA. Coronary artery fistulas: clinical and theurapeutic considerations. Int J Cardiol. 2006;107:7-10

14. Schmid M. Visualization of coronary artery anomalies by contrast-enchanced multi-detector row spiral computed tomography. Int J Cardiol. 2005; 111:430-35.

15. Balanescu S et al. Coronary artery fistulas: clinical consequences and methods of closure. A literature reviews. Ital Heart J.2001;2:669-76
Published
2016-05-02
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How to Cite
Almazini, P., Rahman, A., Yaniarti, D., Sahara, E., Anantaria, C., & Kasim, M. (2016). Coronary Artery Fistula, an Unusual Cause of Chest Pain in Adult : Role of Computed Tomography Angiography. Indonesian Journal of Cardiology, 36(4), 209-19. https://doi.org/10.30701/ijc.v36i4.504
Issue
Vol. 36, No. 4 Oktober - Desember 2015
Section
Case Reports

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