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Published on: February 8, 2022
Mysterious window: A right coronary artery-left ventricular fistula diagnosed by multiple imaging approaches
1Department of Cardiology, Xinhua Hospital affiliated with the School of Medicine, Shanghai JiaoTong University, Shanghai, China.
Insights
A rare case of coronary cameral fistula (CCF) draining into the left ventricle was treated with two surgical interventions. This complex cardiac anomaly required staged procedures for complete resolution.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Medical Imaging
Background:
- Coronary cameral fistula (CCF) is a rare congenital anomaly where a coronary artery abnormally connects to a heart chamber.
- CCF draining into the left ventricle (LV) is exceptionally uncommon, posing diagnostic and therapeutic challenges.
Observation:
- A 45-year-old male presented with a giant aneurysm of the proximal right coronary artery (RCA).
- Echocardiography revealed the distal RCA draining into the LV via a fistula.
- Dual-source CT confirmed the aneurysm, but angiography was limited in visualizing the fistula's drainage due to poor contrast filling.
Findings:
- The patient had a giant aneurysm of the proximal RCA with a fistula draining into the LV.
- Diagnostic imaging presented challenges in fully delineating the fistula's anatomy and drainage site.
- The condition necessitated a two-stage surgical approach for definitive management.
Implications:
- This case highlights the diagnostic difficulties and management strategies for rare CCF involving the LV.
- Successful surgical outcomes can be achieved with staged interventions for complex coronary artery anomalies.
- Further research into imaging modalities and surgical techniques for such rare fistulas is warranted.
Abstract:
Prevalence of primary coronary cameral fistula (CCF) is extremely rare, especially for CCF with its drainage channel into the left ventricle (LV). We describe a 45-year-old male patient with giant aneurysm associated with proximal right coronary artery (RCA), and the distal end of RCA draining into the LV through a fistula, which was discovered by echocardiography. Dual-source computer tomography revealed only the CCF-related giant RCA aneurysm. The drainage site of the fistula and the above coexistent abnormality could not be visualized clearly by coronary artery angiography because of deficient contrast medium filling into the aneurysm. The patient underwent surgical resection of the giant aneurysm and occlusion of the fistula in 2015. Finally, the patient accepted another operation to occlude the residual coronary fistula in 2021.
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