Complete closure of coronary fistula communicating with the descending aorta
Monika Kosiorowska1, Lukas Lehmkuhl2, Paul P Urbanski1
1Department of Cardiovascular Surgery, Cardiovascular Clinic Bad Neustadt, Bad Neustadt, Germany.
Insights
This study details a rare complex coronary artery fistula with aneurysms connected to the descending aorta, requiring surgical intervention. Advanced imaging guided a successful one-stage surgical repair.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Medical Imaging
Background:
- Coronary artery fistulas are rare congenital or acquired abnormal connections between a coronary artery and a cardiac chamber or great vessel.
- Complex fistulas involving multiple aneurysms and aortic pathologies present significant surgical challenges.
Observation:
- A rare case of a complex coronary artery fistula with two aneurysms was identified, directly connecting to the descending aorta.
- Associated aortic pathologies, including aortic valve disease and thoracic aorta abnormalities, were present, necessitating surgical correction.
Findings:
- Preoperative computed tomography angiography (CTA) was instrumental in precisely delineating the abnormal vascular anatomy and planning the surgical approach.
- A successful one-stage surgical procedure involved ligating the coronary origin of the fistula and utilizing the frozen elephant trunk technique for aortic origin repair.
- Simultaneous repair of the aortic valve and thoracic aorta was performed.
Implications:
- This case highlights the importance of advanced imaging in managing complex coronary artery fistulas and associated aortic diseases.
- The described surgical technique demonstrates a feasible approach for treating complex coronary artery fistulas requiring aortic repair.
- Successful surgical management can lead to improved patient outcomes in rare cardiovascular anomalies.
Abstract:
We report a rare case of complex coronary fistula that contained two aneurysms and was connected to the descending aorta. The fistula was also associated with further aortic pathologies necessitating surgery. Preoperative computed tomography angiography, which revealed an abnormal vessel communication, was crucial for choosing the appropriate operative strategy. During a one-stage procedure comprising closure of both arterial (aortic and coronary) fistula origins and repair of the aortic valve and thoracic aorta, the coronary origin of the fistula was ligated and the frozen elephant trunk technique was used to close the aortic origin.
