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 Table of Contents  
CASE REPORT
Year : 2019  |  Volume : 5  |  Issue : 3  |  Page : 213-214

Intercoronary fistula: Rarest of rare coronary anomaly


1 Department of Cardiology, Apex Heart Institute, Ahmedabad, Gujarat, India
2 Department of Cardiology, SMT NHLMMC, Ahmedabad, Gujarat, India

Date of Submission12-Oct-2019
Date of Acceptance10-Nov-2019
Date of Web Publication20-Dec-2019

Correspondence Address:
Dr. Sunil Nichaldas Gurmukhani
Apex Heart Institute, Mondeal Business Park, SG Highway, Ahmedabad - 380 059, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpcs.jpcs_54_19

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  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.

Keywords: Coronary anomalies, computed tomography coronary angiography, Inter-coronary fistula


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 2020 Jul 16];5:213-4. Available from: http://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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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Gillebert C, Van Hoof R, Van de Werf F, Piessens J, De Geest H. Coronary artery fistulas in an adult population. Eur Heart J 1986;7:437-43.  Back to cited text no. 1
    
2.
Cheng TO. Arteriographic demonstration of intercoronary arterial anastomosis in a living man without coronary artery disease. Angiology 1972;23:76-88.  Back to cited text no. 2
    


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