Title : Coronary cameral fistula from the left circumflex artery to the left ventricle contributing to heart failure: A case report
Coronary cameral fistulae are occasionally incidental findings present in less than 1% of the population and 0.1%-0.2% of coronary angiographic studies. In children, coronary artery fistulae account for around half of coronary vasculature anomalies. Most commonly, these drain from the right coronary artery into right-sided chambers. Uncommonly, left-sided chamber drainage occur in 1% of cases. Complications of coronary cameral fistula include development and progression of heart failure as presented in this case report.
We have a case of a 94 year-old female, presenting with easy fatiguability, exertional dyspnea with generalized body weakness. During hospital admission, noted recurrent and persistent pleural effusion despite diuresis and repeated thoracentesis and pigtail insertions. Further evaluation showed elevated NT pro B type natriuretic peptide and 2D echocardiogram findings showing preserved ejection fraction with worsening hypocontractility and diastolic dysfunction, and increasing pulmonary artery pressure. On further workup, coronary angiogram showed normal coronary arteries with note of the left circumflex artery showing a 3.0mm vessel with luminal irregularities draining into the left ventricle consistent with coronary cameral fistula. Patient was then treated with oral medications, diuresis, and was sent home stable.
Audience take away:
- This case presents a coronary cameral fistula with a relatively rare combination of its origin and insertion that presented with worsening echocardiogram findings that could have been partly attributed to the said fistula.
- This report could be helpful to other physicians who are presented with similar findings, may it be from intended or incidental work-up.
- This case report could aid in the importance of medical management when presented with an elderly patient in similar situations.