Diagnosis and Endovascular Treatment of Coronary Artery Fistula: A Case of symptomatic Left-to-Right shunt

Authors

  • Tien En Edward Ong Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore https://orcid.org/0009-0007-3438-518X
  • Justin Kwan Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
  • Sundeep Punamiya Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore

DOI:

https://doi.org/10.3941/jrcr.5637

Abstract

Coronary artery fistulas (CAFs) are rare vascular malformations which constitute abnormal communications from coronary arteries to cardiac chambers, or to parts of the systemic or pulmonary circulation. While small CAFs are usually asymptomatic and often resolve spontaneously, medium or large CAFs can result in haemodynamically significant shunting with progressive dilation. We report a case of CAF originating from the right coronary artery and draining into the coronary sinus, which resulted in pulmonary hypertension and heart failure. The patient subsequently underwent percutaneous flow retardation with vascular plug and coils, leading to significant reduction of shunt flow and clinical improvement. CT and procedural fluoroscopic images are provided.

Selected slices from CT pulmonary angiogram – (a) Dilated pulmonary trunk measuring up to 4.3 cm in diameter (asterisk). (b) Origin of dilated RCA measuring up to 1.7 cm in diameter (dashed arrow). (c) Drainage into a dilated distal coronary sinus (hollow arrow) and enlarged right atrium (solid broad arrow). (d) Tortuous course of the RCA (arrows) and inferior vena caval reflux of contrast. CT acquisition details: Siemens, 120kV, 154 mAs, 1 mm slice thickness, 60 ml IV Omnipaque 350

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Published

2025-02-28

Issue

Vol. 19 No. 2 (2025)

Section

Cardiac Imaging

License

Copyright (c) 2025 Journal of Radiology Case Reports

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