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Coronary artery fistula after cardiac transplantation

A J Chohan1, A D Kugelmass, M Kida

  • 1University of Oklahoma Health Sciences Center, Oklahoma City, USA.

Insights

Coronary artery fistulae developed in a heart transplant patient after biopsies. These rare vascular abnormalities draining into the right ventricle showed a small shunt magnitude over eight years.

Area of Science:

  • Cardiology
  • Transplantation Medicine
  • Vascular Surgery

Background:

  • Cardiac transplant recipients undergo frequent monitoring, including invasive procedures.
  • Endomyocardial biopsies are standard for assessing graft health but carry potential risks.
  • Coronary artery fistulae are abnormal connections between coronary arteries and heart chambers or vessels.

Observation:

  • A case study identified multiple coronary artery fistulae in a cardiac transplant recipient.
  • These fistulae were presumed to arise secondary to repeated endomyocardial biopsy procedures.
  • The fistulae were observed to drain directly into the right ventricle.

Findings:

  • Diagnosis of coronary artery fistulae was confirmed via annual coronary arteriography.
  • The shunt magnitude through the fistulae remained consistently small throughout an eight-year follow-up period.
  • This suggests a potentially benign clinical course for biopsy-induced fistulae in select cases.

Implications:

  • Highlights a rare complication of endomyocardial biopsies in heart transplant patients.
  • Underscores the importance of vigilant surveillance for vascular anomalies post-transplant.
  • Suggests that small-magnitude coronary artery fistulae may not necessitate immediate intervention.

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