Extensively Thrombosed Ectatic Circumflex Coronary Artery Fistula Presenting as Acute Coronary Syndrome

Author(s): Nooraldaem Yousif , Mohammady Shahin , Robert Manka , Slayman Obeid* .

Journal Name: Current Cardiology Reviews

Volume 15 , Issue 4 , 2019

Become EABM
Become Reviewer

Graphical Abstract:


Abstract:

Background: Coronary artery fistula (CAF) is an abnormal communication between the termination of a coronary artery or its branches and a cardiac chamber, a great vessel or other vascular structure. Symptomatic patients with large CAF should undergo surgical or percutanous closure of the fistula at the drainage site while still the debate on closing asymptomatic CAF and reopening symptomatic occluded CAF is ongoing.

Case Summary: We are reporting a 30-year-old male patient with no previous medical history presented as non-ST segment elevation myocardial Infarction. Coronary angiography showed an entirely thrombosed ectatic circumflex artery with a suspicion of thrombosed coronary arterial fistula. In view of the ongoing ischemia in the setting of acute coronary syndrome; we tried to open percutaneously but all efforts were to no avail.

Discussion: In this case report, we are sharing our experience in the management of this challenging case in view of the rarity of such peculiar clinical condition and the unfavourable presentation along with the lack of clear-cut Guideline and Consensus whether to/not to open such huge and immensely thrombosed symptomatic coronary artery fistula as well as the dilemma of choosing the best long-term medical treatment between antiplatelets vs anticoagulants in such young patient.

Keywords: NSTEMI, thrombosis, coronary arterial fistula, antiplatelet, anticoagulation, case report.

[1]
Young PM, Gerber TC, Williamson EE, Julsrud PR, Herfkens RJ. Cardiac imaging: Part 2, normal, variant, and anomalous configurations of the coronary vasculature. AJR Am J Roentgenol 2011; 197: 816-26.
[2]
Angelini P. Coronary artery anomalies-current clinical issues: definitions, classification, incidence, clinical relevance, and treatment guidelines. Tex Heart Inst J 2002; 29: 271-8.
[3]
Shriki JE, Shinbane JS, Rashid MA, et al. Identifying, characterizing, and classifying congenital anomalies of the coronary arteries. Radiographics 2012; 32: 453-68.
[4]
Yamanaka O, Robert E. Hobbs. Coronary artery anomalies in 126,595 patients undergoing coronary arteriography. Cathet Cardiovasc Diagn 1990; 21: 28-40.
[5]
Baltaxe HA, Wixson D. The incidence of congenital anomalies of the coronary arteries in the adult population. Radiology 1977; 122: 47-52.
[6]
Smettei OA, Abazid RM. A rare case of coronary artery fistula presented with acute myocardial infarction. Avicenna J Med 2015; 5(2): 49-51.
[7]
Latson LA. Coronary artery fistulas: How to manage them. Catheter Cardiovasc Interv 2007; 70: 110-6.
[8]
Sünbül M, Papila Topal N, Kıvrak T, Mutlu B. Percutaneous closure of the coronary artery-pulmonary artery fistula in a patient with apical hypertrophic cardiomyopathy. Turk Kardiyol Dern Ars 2013; 41(2): 144-7.
[9]
Wolny R, Pręgowski J, Cyran K, Witkowski A. Acute myocardial infarction due to embolisation from the thrombosed coronary artery fistula between the right coronary artery and the left atrium. Kardiol Pol 2017; 75(7): 720.


Rights & PermissionsPrintExport Cite as

Article Details

VOLUME: 15
ISSUE: 4
Year: 2019
Page: [316 - 319]
Pages: 4
DOI: 10.2174/1573403X15666181206120138
Price: $58

Article Metrics

PDF: 26
HTML: 2
EPUB: 1
PRC: 1