Korean Circ J.  2013 May;43(5):351-355. 10.4070/kcj.2013.43.5.351.

Spontaneous Partial Regression of Coronary Artery Fistula Following Optimal Medical Therapy in a Patient Who Had Combined Significant Coronary Artery Spasm

• Lee S
• Rha SW
• Kook H
• Kim DH
• Oh SK
• Cho DH
• Kim W
• Oh DJ

• KMID: 2224936
• DOI: http://doi.org/10.4070/kcj.2013.43.5.351

Abstract

Coronary artery fistulas (CAFs) are one of the most rare cardiac anomalies. Some patients with CAF may suffer from ischemic chest pain that originates from combined significant coronary artery spasm (CAS). Spontaneous regression of CAF has been reported in a few cases, almost all of which were infants. We report an adult patient who presented with ischemic chest pain due to multiple coronary arteries to pulmonary artery fistulas and combined significant CAS induced by intracoronary acetylcholine provocation test. Spontaneous regression of one of the fistulas was observed at 2-year angiography follow-up.

Keyword

Coronary vessel anomalies; Arteriovenous fistula; Coronary artery vasospasm

MeSH Terms

Acetylcholine
Adult
Angiography
Arteriovenous Fistula
Chest Pain
Coronary Vasospasm
Coronary Vessel Anomalies
Coronary Vessels
Fistula
Follow-Up Studies
Humans
Infant
Pulmonary Artery
Spasm
Acetylcholine

Figure

• 

  Fig. 1 Coronary arteriovenous fistulas originating from both left and right coronary arteries. A: one fistula originated from the left main (arrow), and the other from the left anterior descending artery (arrowhead). B: fistula originating from the proximal right coronary artery (arrow).

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  Fig. 2 The mid to distal left anterior descending artery and left circumflex artery showed significant diffuse vasoconstriction with chest pain after intracoronary acetylcholine injection (100 ug, A) which was reversed by nitroglycerin injection (200 ug, B).

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  Fig. 3 Coronary multi-detector CT findings. Anomalous coronary arteriovenous fistulas from proximal left main artery to pulmonary artery (A), proximal left anterior descending artery to pulmonary artery (B), proximal right coronary artery to pulmonary artery (C).

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  Fig. 4 Follow-up coronary angiography at two years. A and B: follow-up left coronary angiogram shows no remarkable change in both fistulas. C: previous right coronary angiogram. D: follow-up right coronary angiogram showing that the previous fistula from the right coronary artery has spontaneously regressed.

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