A case report of a coronary artery fistula to coronary sinus with giant aneurysm: risk does not end with repair.

Eur Heart J Case Rep

Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, Piazza Edmondo Malan 2, 20097, San Donato Milanese, Italy.

Published: December 2020


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Article Abstract

Background: Isolated coronary arteriovenous fistulas are extremely rare, accounting for 0.08-0.4% of all congenital heart disease. Closure of the fistula is recommended in cases of large dimensions, relevant left-right shunt, or ischaemic events. Thrombosis of the coronary aneurysms may occur as a postoperative complication.

Case Summary: We report a case of a coronary fistula between the circumflex artery and coronary sinus with giant aneurysm. After a failed percutaneous closure attempt, the patient was surgically treated without major postoperative complications. Despite therapeutic anticoagulation and antiplatelet therapy, she presented at clinical follow-up with thrombosis of the dilated coronary artery without signs or symptoms of ischaemia.

Discussion: Management of coronary artery fistula may be challenging in cases in which initial percutaneous closure is unsuccessful. This particular case also highlights the importance of close follow-up, despite optimal therapy, to detect potentially lethal complications related to the low flow in the dilated coronary aneurysm.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7793215PMC
http://dx.doi.org/10.1093/ehjcr/ytaa297DOI Listing

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