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Coronary arteriovenous fistulas with giant aneurysm: two case reports
1First Department of Surgery, Yamaguchi University School of Medicine, Ube, Japan.
Insights
Rare cases of coronary arteriovenous fistulas with giant aneurysms were successfully treated. Surgical ligation of these complex coronary artery fistulas and associated plexal vessels ensured preservation of native coronary circulation.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Medicine
Background:
- Coronary arteriovenous fistulas (CAFs) are uncommon vascular anomalies.
- Giant aneurysmal formation associated with CAFs is exceptionally rare.
- This study details two unique cases presenting this rare combination.
Observation:
- One patient presented with a right coronary fistula draining into the superior vena cava.
- The second patient had a left coronary fistula draining into the main pulmonary artery, with complex plexal vessels.
- Both cases involved giant aneurysmal dilation of the affected coronary artery.
Findings:
- Successful surgical ligation of the coronary arteriovenous fistulas and associated plexal vessels was achieved in both patients.
- The procedures were performed under cardiopulmonary bypass.
- No injury to the native coronary circulation occurred during the interventions.
Implications:
- This demonstrates the feasibility and safety of surgical correction for complex CAFs with giant aneurysms.
- Effective management strategies can be employed even in rare and intricate cardiovascular presentations.
- Preservation of native coronary flow is achievable, optimizing patient outcomes.
Abstract:
Coronary arteriovenous fistulas are rare, particularly in association with coronary aneurysms. Two rare cases of patients with coronary arteriovenous fistulas and giant aneurysmal formation are described. A right coronary fistula that drained into the superior vena cava was demonstrated in one patient. The remaining patient had a documented left coronary fistula that drained into a main pulmonary artery and had evidence of several plexal vessels that transversed through the pulmonary trunk and toward the pericardial reflex. Under cardiopulmonary bypass, the fistulas and plexal vessels were successfully ligated without any injury to the native coronary circulation.