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Two Cases of Post-Operative Coronary-Cameral Fistulas After Unusual Myectomy Procedures
Neda Toofaninejad1, Arezoo Hajiali1, Mahtab Hatami1
1Department of Echocardiography, Tehran Heart Center, Cardiovascular Research Institute Tehran University of Medical Science Tehran Iran.
Insights
Acquired coronary-cameral fistulas (CCFs) are rare post-surgical complications. Small CCFs are often asymptomatic, detected incidentally, and may resolve spontaneously with conservative management.
Area of Science:
- Cardiology
- Cardiac Surgery
- Interventional Cardiology
Background:
- Acquired coronary-cameral fistulas (CCFs) are uncommon abnormal connections between coronary arteries and cardiac chambers.
- Causes include trauma, myocardial infarction, and iatrogenic injury from cardiac procedures like percutaneous coronary intervention (PCI), pacemaker implantation, and surgery.
Purpose of the Study:
- To report two cases of post-surgical CCF.
- To highlight the presentation, detection, and management of these rare complications.
Main Methods:
- Case report of two patients with post-surgical CCF.
- Postoperative echocardiography for fistula detection.
- Conservative management approach.
Main Results:
- Two cases of CCF following cardiac surgery were identified: one in the right ventricular outflow tract (RVOT) and another in the left ventricular outflow tract (LVOT).
- Both fistulas were small, hemodynamically insignificant, and detected postoperatively via echocardiography.
- Both patients were managed conservatively with no intervention required.
Conclusions:
- Post-surgical CCFs are typically asymptomatic and incidentally found.
- These fistulas may persist or spontaneously close.
- Vigilance for this complication and appropriate imaging are crucial for management and follow-up.
Abstract:
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.
