Genesis of a coronary-cameral fistula
Benoy Nalin Shah1, Ausami Abbas2
1Department of Cardiology, Wessex Cardiac Centre, University Hospital Southampton, Southampton, UK.
Insights
This case study describes a rare instance of coronary artery aneurysms evolving into a coronary-cameral fistula over a decade. The fistula formed when an aneurysm expanded into the right atrium, highlighting a unique presentation of this congenital abnormality.
Area of Science:
- Cardiology
- Congenital Heart Disease
Background:
- Coronary artery fistulae are uncommon, with coronary-cameral fistulae draining directly into heart chambers.
- These anomalies are typically congenital but can be iatrogenic, resulting from cardiac procedures.
Observation:
- A patient initially presented with coronary aneurysms, with the largest noted nearly a decade prior.
- The primary coronary aneurysm significantly enlarged over the intervening decade.
Findings:
- The enlarged coronary aneurysm eroded into the right atrium, forming a coronary-cameral fistula.
- This represents a highly unusual, delayed presentation of a coronary artery abnormality.
Implications:
- This case underscores the potential for coronary aneurysms to develop into fistulae over time.
- It highlights the importance of long-term monitoring for patients with coronary aneurysms, particularly those with potential for expansion.
Abstract:
Coronary artery fistulae are a rare congenital abnormality. If such fistulae drain directly into a cardiac chamber, they are termed coronary-cameral fistulae. Such fistulae are usually congenital in origin or, occasionally, may arise as an iatrogenic complication of a cardiac procedure such as cardiac catheterization or surgery. We present a highly unusual case in which a patient presented to cardiac services on two occasions-nearly a decade apart-and was found to have coronary aneurysms initially, the largest of which expanded further and into the right atrium, thus creating a coronary-cameral fistula.
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