Correspondence Address: Dr. Sunil Nichaldas Gurmukhani Apex Heart Institute, Mondeal Business Park, SG Highway, Ahmedabad - 380 059, Gujarat India
Source of Support: None, Conflict of Interest: None
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DOI: 10.4103/jpcs.jpcs_54_19
Abstract
Coronary artery fistulas are rare but fascinating anomalies. It is defined as an abnormal direct vascular connection from coronary artery to a cardiac chamber or major central blood vessel without an intervening capillary bed. Among all coronary fistulas, intercoronary fistula without obstructive coronary artery disease is extremely rare. Such huge intercoronary fistula without any obstructive coronary artery disease is not described previously in literature to best of our knowledge. Clinical significance and future implications of these anomalies is unknown and subject of debate.
How to cite this article: Gurmukhani SN, Chaturvedi N, Saradava N, Mutha S, Shah S, Patel T. Intercoronary fistula: Rarest of rare coronary anomaly. J Pract Cardiovasc Sci 2019;5:213-4
How to cite this URL: Gurmukhani SN, Chaturvedi N, Saradava N, Mutha S, Shah S, Patel T. Intercoronary fistula: Rarest of rare coronary anomaly. J Pract Cardiovasc Sci [serial online] 2019 [cited 2023 Jun 10];5:213-4. Available from: https://www.j-pcs.org/text.asp?2019/5/3/213/273746
A hypertensive, nondiabetic male patient in his 50s presented to us with atypical angina. General examination was notable for corneal arcus and polydactyl. Cardiovascular system examination was unremarkable except Levine grade II systolic murmur in the left parasternal area. Transthoracic two-dimensional echocardiogram showed huge right coronary artery (RCA) originating from right coronary cusp (RCC) in short-axis view [[Figure 1]a and Video 1] and turbulent flow was demonstrated in the posterior atrioventricular (AV) groove on color Doppler in four-chamber view [Video 2]. We suspected coronary artery fistula as a cause of his murmur, and we decided to perform selective coronary angiogram to confirm our diagnosis. Selective coronary arteriography revealed a huge RCA draining into fistula in AV groove [Figure 1]b and Videos 3-5] without any significant obstructive coronary artery disease. Computed tomography coronary angiography confirmed intercoronary fistula connecting RCA to left circumflex artery [Figure 1]c and [Figure 1]d. Coronary artery fistulas are rare but fascinating anomalies. It is defined as an abnormal direct vascular connection from coronary artery to a cardiac chamber or major central blood vessel without an intervening capillary bed. Coronary artery fistulas are seen in 0.13%–0.22% of adults undergoing coronary angiography.[1] Among all coronary fistulas, intercoronary fistula without obstructive coronary artery disease is extremely rare; the first documentation of such anomaly was done by Cheng in 1973.[2] Such huge intercoronary fistula without any obstructive coronary artery disease is not described previously in literature to best of our knowledge. Clinical significance and future implications of these anomalies are unknown and subject of debate.
Figure 1: (a) Origin of huge right coronary artery from aorta in short-axis view. (b) Angiogram of gigantic right coronary artery in left anterior oblique view. (c and d) Large intercoronary fistula connecting two (right and left) coronary circulations.
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