Prenatal Diagnosis of Coronary Artery Fistula: A Case Report and Review of Literature

Abstract

We report an antenatally diagnosed large distal coronary artery fistula (CAF) arising from an aneurysmal dilation right coronary artery (RCA) and draining in to the right ventricle (RV) just below the septal leaflet of tricuspid valve posteriorly. A postnatal echocardiogram confirmed the diagnosis. On the second day of life, a percutaneous partial closure of the fistula was performed by placing a Flipper coil (Cook Medical, Bloomington, IN) in the RCA just proximal to the drainage site in the cardiac catheterization laboratory. Follow-up echocardiogram on the day following the procedure showed improved forward flow in the descending aorta with decreased RV size. Our case report suggests that antenatal diagnosis of a CAF may aid in early intervention. Partial closure of the fistula in the cardiac catheterization laboratory is safe and effective.

Keywords

prenatal diagnosis - coronary artery fistula - heart failure

Notes

The institution at which the work was performed was Children's Hospital of Michigan, Detroit, MI.

• References

• 1 Krause W. Ueber den ursprung einer accessorischen a. coronaria cordis aus der a. pulmonalis. Z Rat Med 1865; 24: 225-227
• 2 Daniel M, Mavroudis C, Preminger T, Lorber RO, Jacobs ML. Prenatal diagnosis and neonatal surgical management of a giant proximal right coronary artery to right ventricular fistula. World J Pediatr Congenit Heart Surg 2010; 1 (2) 243-248
• 3 Cotton JL. Diagnosis of a left coronary artery to right ventricular fistula with progression to spontaneous closure. J Am Soc Echocardiogr 2000; 13 (3) 225-228
• 4 Sharland GK, Tynan M, Qureshi SA. Prenatal detection and progression of right coronary artery to right ventricle fistula. Heart 1996; 76 (1) 79-81
• 5 Hayashi T, Inuzuka R, Ono H, Katori T. Prenatal diagnosis of coronary artery fistula: a case report and review of literature. Pediatr Int 2012; 54 (2) 299-302
• 6 Karagöz T, Özkutlu S, Celiker A. Percutaneous closure of a prenatally diagnosed large coronary artery fistula with an Amplatzer vascular plug immediately after delivery. Acta Cardiol 2008; 63 (3) 405-408
• 7 Zhao X, Yang Y, Li RJ. A large hemodynamically significant right coronary artery fistula to right ventricle: prenatal detection and progression. Echocardiography 2012; 29 (7) E173-E175
• 8 Khan MD, Qureshi SA, Rosenthal E, Sharland GK. Neonatal transcatheter occlusion of a large coronary artery fistula with Amplatzer duct occluder. Catheter Cardiovasc Interv 2003; 60 (2) 282-286
• 9 Hung JH, Lu JH, Hung J, Chen JD. Prenatal diagnosis of a right coronary-cameral fistula. J Ultrasound Med 2006; 25 (8) 1075-1078
• 10 Mielke G, Sieverding L, Borth-Bruns T, Eichhorn K, Wallwiener D, Gembruch U. Prenatal diagnosis and perinatal management of left coronary artery to right atrium fistula. Ultrasound Obstet Gynecol 2002; 19 (6) 612-615
• 11 Gowda ST, Forbes TJ, Singh H , et al. Remodeling and thrombosis following closure of coronary artery fistula with review of management: large distal coronary artery fistula—to close or not to close?. Catheter Cardiovasc Interv 2013; 82 (1) 132-142