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Spontaneous rupture of a coronary artery fistula presenting with post-exertional syncope and haemopericardium

Manan H Desai1,2, Laura J Olivieri3, Karthik V Ramakrishnan1,4

  • 1Division of Cardiac Surgery, Children's National Hospital, Washington, DC, USA.

Interactive Cardiovascular and Thoracic Surgery
|December 28, 2020
PubMed

Insights

A child with an asymptomatic coronary artery fistula (CAF) experienced a life-threatening rupture, requiring emergency surgery. This case highlights the critical need for vigilance and prompt management of CAF complications.

Area of Science:

  • Cardiology
  • Pediatric Cardiology
  • Congenital Heart Disease

Background:

  • Coronary artery fistulas (CAFs) are abnormal connections between a coronary artery and a heart chamber or major vessel.
  • While often asymptomatic, CAFs can lead to serious complications, including rupture.

Observation:

  • An 8-year-old presented with exertional syncope and hemopericardium.
  • This was attributed to a contained rupture of a previously asymptomatic coronary artery fistula.

Findings:

  • Initial transcatheter closure attempt failed, with the fistula rupturing again.
  • Emergency surgical repair was necessitated due to the recurrent rupture.

Implications:

  • Spontaneous rupture of CAF is a rare but catastrophic event.
  • A high index of suspicion, timely diagnosis, and multidisciplinary team management are crucial for patients with CAF.

Keywords:
Coronary artery fistulaHaemopericardiumSyncope

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