Two Cases of Post-Operative Coronary-Cameral Fistulas After Unusual Myectomy Procedures

Acquired coronary-cameral fistulas (CCFs) are rare complications characterized by abnormal communication between a coronary artery and a cardiac chamber. They may result from chest trauma, myocardial infarction, or iatrogenic injury during cardiac procedures, including percutaneous coronary intervention (PCI), pacemaker lead implantation, and cardiac surgery. We report two cases of post-surgical CCF. The first case is a 50-year-old man with a double-chambered RV who developed a small fistula to the right ventricular outflow tract (RVOT) following resection of the hypertrophied RV muscle bundle. The second case is a 41-year-old woman with a fistula from the basal interventricular septum into the left ventricular outflow tract (LVOT) after redo subaortic web resection and septal myectomy. Both fistulas were detected on postoperative echocardiography and were hemodynamically insignificant. Both patients were managed conservatively without intervention, consistent with the usual course of small post-surgical CCFs. Post-surgical CCFs are typically asymptomatic, often detected incidentally, and may persist or close spontaneously. Awareness of this complication and careful imaging are essential for appropriate follow-up and management.