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Acquired (post-angioplasty) coronary ventricular fistula draining into left ventricle aneurysm

Amit Gupta1, Sudheer Saxena

  • 1Department of Cardiology at Mukat Hospital, Ludhiana (Punjab), India, 1 41003. docamitgupta@yahoo.co.in

The Journal of Invasive Cardiology
|May 8, 2012
PubMed

Insights

A rare coronary artery fistula developed after bypass surgery, connecting a coronary artery branch to a left ventricle aneurysm. This case suggests a contained rupture or pulsatile erosion as potential causes.

Area of Science:

  • Cardiology
  • Vascular Surgery

Background:

  • Coronary artery fistula is a rare vascular anomaly with congenital or acquired origins.
  • Acquired fistulas can result from trauma, cardiac surgery, angioplasty, or coronary aneurysm rupture.

Observation:

  • A unique case of a post-coronary artery bypass graft surgery patient presented with a fistula.
  • The fistula involved the second obtuse marginal branch of the left circumflex coronary artery.
  • This anomalous connection drained into a left ventricle aneurysm.

Findings:

  • The study explored potential causes for the acquired fistula in this specific case.
  • Erosion of the thin aneurysmal wall into the coronary lumen was considered.
  • A contained rupture or pulsatile erosion from the obtuse marginal branch into the aneurysm was hypothesized, given the surgical history.

Implications:

  • This case highlights a rare complication following coronary artery bypass graft surgery.
  • Understanding the pathogenesis of acquired coronary artery fistulas is crucial for diagnosis and management.
  • Further investigation into the mechanisms of contained rupture and pulsatile erosion in aneurysmal disease is warranted.

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