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Coronary arteriovenous fistula presenting as congestive heart failure
A D Kugelmass1, W J Manning, R N Piana
1Charles A. Dana Research Institute, Boston, Massachusetts.
Insights
Rare coronary arteriovenous fistulae can significantly impact hemodynamics. This case highlights a circumflex-coronary sinus fistula causing heart failure and murmur, diagnosed noninvasively.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Medical Imaging
Background:
- Coronary arteriovenous fistulae (CAVF) are uncommon congenital or acquired abnormalities.
- These fistulae can lead to significant hemodynamic alterations and clinical manifestations.
Observation:
- A case of a circumflex-coronary sinus fistula in an elderly male is presented.
- The patient exhibited a loud continuous murmur and symptoms of congestive heart failure.
Findings:
- Noninvasive imaging modalities, including transesophageal echocardiography and magnetic resonance imaging, were instrumental in suggesting the diagnosis.
- Diagnosing concurrent atherosclerotic coronary artery disease alongside the fistula presented challenges, potentially necessitating further investigation post-surgery.
Implications:
- This case underscores the importance of considering rare coronary anomalies in patients with unexplained murmurs and heart failure.
- Effective noninvasive diagnostic strategies are crucial for identifying these fistulae.
- Management may require a multidisciplinary approach, considering both the fistula and any associated coronary artery disease.
Abstract:
Coronary arteriovenous fistulae are rare, but can be of hemodynamic significance. We report a circumflex-coronary sinus fistula in an elderly man which was associated with a loud continuous murmur and congestive heart failure. Noninvasive evaluation, including transesophageal echocardiography and magnetic resonance imaging, suggested the diagnosis. Angiographic diagnosis of concomitant atherosclerotic coronary disease may be difficult, and can require postoperative study.