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Aneurysmal Coronary Artery Fistulae: How Big is Big Enough?

Abhishek Jaiswal1, Chong H Park1

  • 1Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, New York Hospital Queens/Weill Medical College of Cornell University, New York, New York.

The International Journal of Angiology : Official Publication of the International College of Angiology, Inc
|July 31, 2014
PubMed

Insights

Asymptomatic coronary artery fistula (CAF) diagnosis is rising, posing management challenges. This case highlights successful coil treatment for a large, incidentally found coronary artery to pulmonary artery fistula in an elderly patient.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Congenital Heart Disease

Background:

  • Coronary artery fistula (CAF) is the most common congenital anomaly of coronary arteries.
  • Management of symptomatic or large-shunt CAFs is established.
  • Increasing use of noninvasive imaging leads to more incidental CAF diagnoses, creating management dilemmas for asymptomatic cases with high-risk features.

Observation:

  • A 78-year-old asymptomatic woman presented with a large saccular coronary aneurysm.
  • The aneurysm was associated with a coronary artery to pulmonary artery fistula.
  • The incidental finding posed a management challenge due to the patient's asymptomatic status.

Findings:

  • The patient's large coronary artery to pulmonary artery fistula was successfully treated using endovascular coils.
  • This case demonstrates a viable therapeutic option for incidentally diagnosed, high-risk CAFs.

Implications:

  • The management of asymptomatic CAFs, particularly those with high-risk features like large aneurysms, requires careful consideration.
  • Coil embolization presents a safe and effective treatment for selected cases of coronary artery fistula.
  • Further research is needed to clarify the true risk of complications in asymptomatic CAFs and refine therapeutic strategies.

Keywords:
coilscoronary aneurysmcoronary angiographycoronary artery fistulatranscatheter interventions

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