Right Coronary Artery to Superior Vena Cava Fistula Following CABG: A Very Rare Case Report

Document Type : Case Report/Series

Authors

1 Assistant Professor, Department of Cardiac Surgery, Faculty of Medical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran

2 General Physician, Faculty of Medical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran

3 Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

4 Resident of Cardiac Surgery, Department of Cardiac Surgery, Faculty of Medical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran

5 Nursing Anesthesia of Cardiovascular Surgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

6 Associated Professor, Department of Cardiac Surgery, Faculty of Medical Sciences, Mashhad University of Medical Sciences, Mashhad

Abstract

Introduction : Although most coronary artery fistulas to the venous system are congenital, we present a case who was conservatively treated and developed an acquired post-coronary artery bypass grafting (CABG) fistula between the right coronary artery (RCA) and superior vena cava (SVC) that due to with allow-flow shunt and few symptoms.

Case presentation: We report a 65-year-old man with a history of CABG 3 years ago presenting with chest pain. He developed a 3-vessel disease as well as a recent myocardial infarction with a reduced ejection fraction (25%). The case had chest discomfort since 2 months ago after discharge increasing by any physical activity. The consultant cardiologist decided to perform coronary angiography to assess the condition of the native coronary artery and coronary grafts. On coronary angiography, all of the grafts were patent; however, there was an abnormal communication between the proximal of native RCA and SVC that finally filled the right atrium.

Conclusion: Clinically, although most coronary artery fistulas are silent and asymptomatic due to the limited size of the shunt, in some rare cases in which there is a large shunt and steal of coronary circulation, the symptoms and signs of ischemic heart disease appear that there are surgical and interventional options for closure of this abnormal communications.

Keywords

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

References

1. Wei J, Azarbal B, Singh S, et al. Frequency of coronary artery fistulae is increased after orthotopic heart transplantation. J Heart Lung Transplant. 2013;32(7):744-746
https://doi.org/10.1016/j.healun.2013.04.009
PMid:23664527
 
2. Said SA. Current characteristics of congenital coronary artery fistulas in adults: a decade of global experience. World J Cardiol. 2011;3(8):267-277
https://doi.org/10.4330/wjc.v3.i8.267
PMid:21876777 PMCid:PMC3163242
 
3. Kobashigawa JA, Patel J, Furukawa H, et al. Five-year results of a randomized, single-center study of tacrolimus vs microemulsion cyclosporine in heart transplant patients. J Heart Lung Transplant. 2006;25(4):434-439
https://doi.org/10.1016/j.healun.2005.11.452
PMid:16563974
 
4. Hajj-Chahine J, Haddad F, El-Rassi I, Jebara V. Surgical management of a circumflex aneurysm with fistula to the coronary sinus. Eur J Cardiothorac Surg. 2009;35(6):1086-1088
https://doi.org/10.1016/j.ejcts.2009.02.039
PMid:19356944
 
5. Yamanaka O, Hobbs RE. Coronary artery anomalies in 126,595 patients undergoing coronary arteriography. Cathet Cardiovasc Diagn. 1990;21(1):28-40.
https://doi.org/10.1002/ccd.1810210110
PMid:2208265
 
6. Said SA, Gamal MI el, Werf T van der. Coronary arteriovenous fistulas: collective review and management of six new cases-changing etiology, presentation, and treatment strategy. ClinCardiol. 1997;20(9):748-752.
https://doi.org/10.1002/clc.4960200907
PMid:9294664 PMCid:PMC6656001
 
7. chmitt R, Froehner S, Brunn J, Wagner M, Brunner H, Cherevatyy O, Gietzen F, Christopoulos G, Kerber S, Fellner F. Congenital anomalies of the coronary arteries: imaging with contrast-enhanced, multidetector computed tomography. EurRadiol. 2005;15:1110-1121.
https://doi.org/10.1007/s00330-005-2707-z
PMid:15756551
 
8. Kacmaz F, IsiksalanOzbulbul N, Alyan O, Maden O, Demir AD, Atak R, Senen K, Erbay AR, Balbay Y, Olcer T, et al. Imaging of coronary artery fistulas by multidetector computed tomography: is multidetector computed tomography sensitive? ClinCardiol. 2008;31:41-47.
https://doi.org/10.1002/clc.20286
PMid:18203118 PMCid:PMC6653316
 
9. Parga JR, Ikari NM, Bustamante LN, Rochitte CE, de Avila LF, Oliveira SA. Case report: MRI evaluation of congenital coronary artery fistulae. Br J Radiol. 2004;77:508-511.
https://doi.org/10.1259/bjr/24835123
PMid:15151973
 
10. Said SA, Lam J, van der Werf T. Solitary coronary artery fistulas: a congenital anomaly in children and adults. A contemporary review. Congenit Heart Dis. 2006;1:63-76
https://doi.org/10.1111/j.1747-0803.2006.00012.x
PMid:18377549
 
11. Gowda RM, Vasavada BC, Khan IA. Coronary artery fistulas: clinical and therapeutic considerations. Int J Cardiol. 2006;107:7-10
https://doi.org/10.1016/j.ijcard.2005.01.067
PMid:16125261
 
12. Zeina AR, Blinder J, Rosenschein U, Barmeir E. Coronary-pulmonary artery fistula diagnosed by multidetector computed tomography. Postgrad Med J. 2006;82:e15
https://doi.org/10.1136/pgmj.2005.044172
PMid:16822914 PMCid:PMC2563772
 
13. Yanagihara K, Ueno Y, Kobayashi T, Isobe J, Watanabe S, Itoh M. Coronary artery fistula into a persistent left superior vena cava: report of a case. Surg Today. 1997;27:966-968
https://doi.org/10.1007/BF02388148
PMid:10870586
 
14. . Khunnawat C, Mukerji S, Abela GS, Thakur RK. Unusual complications of coronary artery bypass graft surgery. Am J Cardiol. 2006;98:1665-1666
https://doi.org/10.1016/j.amjcard.2006.07.048
PMid:17145231
Razavi International Journal of Medicine
Volume 9, Issue 1
January 2021
Pages 69-72

Files

Share

How to cite

Statistics