Severe Dilated Cardiomyopathy Resulted from a Large Single Coronary Artery Fistula Drained Into the Left Ventricle
DCMP by Single Coronary Artery Fistula drained to the LV
DOI:
https://doi.org/10.1532/hsf.3013Keywords:
congenital coronary artery anomaly, single coronary artery, coronary artery fistula, dilated cardiomyopathy, surgical closureAbstract
Background: Coronary artery fistula (CAF) draining into the left ventricle (LV) is a rare condition and dilated cardiomyopathy (DCMP) that results from single coronary artery (SCA) accompanied by CAF also is extremely rare.
Case report: We report the case of a 36-year-old man, who presented with severe DCMP that resulted from SCA with CAF draining into the LV. Transthoracic echocardiogram (TTE) showed severe diffuse hypokinesia of the LV with ejection fraction (EF) of 15-20%. Coronary angiography (CAG) revealed SCA connected between left anterior descending artery (LAD) and posterior descending artery (PDA), course of the PDA was very tortuous from apex to base of the LV, and connected to posterior lateral (PL) branch, which was drained into the LV at distal part of the PL. Coronary artery computed tomography (CACT) showed LAD ran over the apex of the LV and connected to PDA, which was drained into the mid portion of lateral wall of the LV. Cardiac magnetic resonance imaging (CMRI) showed no evidence of irreversible myocardial change in global wall of the LV. The patient underwent surgical ligation of PDA near the base of the posterior wall of the LV as close to the entry of CAF to the LV as possible without any surgery-related complications. Three months after the surgical ligation, follow-up TEE showed much improved EF of 45-50%. He has been doing well without congestive heart failure (CHF) until now.
Discussion: Symptomatic CAF with hemodynamic deterioration may need mechanical correction of CAF, including surgical ligation or percutaneous interventional occlusion. How to treat this condition in terms of methodology is a very difficult issue. The detailed methods related to surgical or interventional correction of CAF have to be determined based on anatomical characteristics of CAF, underlying comorbidities, and relevant
complications risk.
References
Carrel T, Tkebuchava T, Jenni R, Arbenz U, Turina M. 1996. Congenital coronary fistulas in children and adults: diagnosis, surgical technique and results. Cardiology. 87(4):325-330.
Cheng TO. 1982. Left coronary artery-to-left ventricular fistula: demonstration of coronary steal phenomenon. Am Heart J. 104(4 Pt 1):870-872.
Cheung DL, Au WK, Cheung HH, Chiu CS, Lee WT. 2001. Coronary artery fistulas: long-term results of surgical correction. Ann Thorac Surg. 71(1):190-195.
Fernandes ED, Kadivar H, Hallman GL, Reul GJ, Ott DA, Cooley DA. 1992. Congenital malformations of the coronary arteries: the Texas Heart Institute experience. Ann Thorac Surg. 54(4):732-740.
Jebara VA, Sarkis A, Acar C, et al. 1991. Coronary artery-left ventricle fistulas after cardiac surgery. Am Heart J. 122(6):1759-1762.
Kabbani Z, Garcia-Nielsen L, Lozano ML, Febles T, Febles-Bethencourt L, Castro A. 2008. Coil embolization of coronary artery fistulas. A single-centre experience. Cardiovasc Revascularization Med Mol Interv. 9(1):14-17.
Kamiya H, Yasuda T, Nagamine H, et al. 2002. Surgical treatment of congenital coronary artery fistulas: 27 years’ experience and a review of the literature. J Card Surg. 17(2):173-177.
Kassaian SE, Mahmoodian M, Salarifar M, Alidoosti M, Abbasi SH, Rasekh A. 2007. Stent-graft exclusion of multiple symptomatic coronary artery fistulae. Tex Heart Inst J. 34(2):199-202.
Luo L, Kebede S, Wu S, Stouffer GA. Coronary artery fistulae. 2006. Am J Med Sci. 332(2):79-84.
Mangukia CV. 2012. Coronary artery fistula. Ann Thorac Surg. 93(6):2084-2092.
Mavroudis C, Backer CL, Rocchini AP, Muster AJ, Gevitz M. 1997. Coronary artery fistulas in infants and children: a surgical review and discussion of coil embolization. Ann Thorac Surg. 63(5):1235-1242.
Oshiro K, Shimabukuro M, Nakada Y, et al. 1990. Multiple coronary LV fistulas: demonstration of coronary steal phenomenon by stress thallium scintigraphy and exercise hemodynamics. Am Heart J. 120(1):217-219.
Reul RM, Cooley DA, Hallman GL, Reul GJ. 2002. Surgical treatment of coronary artery anomalies: report of a 37 1/2-year experience at the Texas Heart Institute. Tex Heart Inst J. 29(4):299-307.
Roberts WC. 1986. Major anomalies of coronary arterial origin seen in adulthood. Am Heart J. 111(5):941-963.
Urrutia-S CO, Falaschi G, Ott DA, Cooley DA. 1983. Surgical management of 56 patients with congenital coronary artery fistulas. Ann Thorac Surg. 35(3):300-307.
