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Introduction: Coronary cameral fistulas (CCFs) are rare congenital anomalies characterized by abnormal connections between a coronary artery and one of the cardiac chambers. These abnormal connections can lead to significant clinical implications, including heart failure and myocardial ischemia, necessitating timely diagnosis and intervention. Case presentation: A 5-year-old Iranian boy was brought to the emergency room at Heart Hospital Center complaining of chest pain and dyspnea on exertion. He had experienced similar episodes over the past 4 months, which had not been evaluated. Physical examination revealed stable vital signs and no remarkable findings. Transthoracic echocardiography demonstrated a dilated left coronary artery with a large aneurysm and a small orifice to the right ventricular body. The left ventricular ejection fraction was 55%. Cardiac computed tomography angiography confirmed the diagnosis. Cardiac angiography showed a dilated left coronary artery and a coronary cameral fistula to the right ventricular. The aneurysm was successfully occluded using two Amplatzer™ devices. Conclusion: This case underscores the critical role of multimodal imaging in diagnosing and managing coronary cameral fistulae. Early detection and appropriate intervention are paramount in preventing the progression of symptoms and potential complications such as heart failure and myocardial ischemia. The successful closure with Amplatzer™ devices highlights the efficacy of minimally invasive techniques in treating complex cardiovascular anomalies. Regular follow-up and careful monitoring are essential to ensure long-term success and to manage any potential recurrences. Clinical key message: Timely identification and management of coronary cameral fistulae are crucial to prevent complications. Advances in imaging techniques and minimally invasive treatments, such as transcatheter closure, offer effective solutions. A multidisciplinary approach and regular follow-up are essential for comprehensive care and successful long-term management. [ABSTRACT FROM AUTHOR]

Abstract Introduction Coronary cameral fistulas (CCFs) are rare congenital anomalies characterized by abnormal connections between a coronary artery and one of the cardiac chambers. These abnormal connections can lead to significant clinical implications, including heart failure and myocardial ischemia, necessitating timely diagnosis and intervention. Case presentation A 5-year-old Iranian boy was brought to the emergency room at Heart Hospital Center complaining of chest pain and dyspnea on exertion. He had experienced similar episodes over the past 4 months, which had not been evaluated. Physical examination revealed stable vital signs and no remarkable findings. Transthoracic echocardiography demonstrated a dilated left coronary artery with a large aneurysm and a small orifice to the right ventricular body. The left ventricular ejection fraction was 55%. Cardiac computed tomography angiography confirmed the diagnosis. Cardiac angiography showed a dilated left coronary artery and a coronary cameral fistula to the right ventricular . The aneurysm was successfully occluded using two Amplatzer™ devices. Conclusion This case underscores the critical role of multimodal imaging in diagnosing and managing coronary cameral fistulae. Early detection and appropriate intervention are paramount in preventing the progression of symptoms and potential complications such as heart failure and myocardial ischemia. The successful closure with Amplatzer™ devices highlights the efficacy of minimally invasive techniques in treating complex cardiovascular anomalies. Regular follow-up and careful monitoring are essential to ensure long-term success and to manage any potential recurrences. Clinical key message Timely identification and management of coronary cameral fistulae are crucial to prevent complications. Advances in imaging techniques and minimally invasive treatments, such as transcatheter closure, offer effective solutions. A multidisciplinary approach and regular follow-up are essential for comprehensive care and successful long-term management.

A coronary artery fistula (CAF) is an abnormal vascular connection between the coronary arteries and the cardiac chambers or major vessels. Although rare, CAFs can lead to substantial coronary morbidity and mortality. This study outlines the surgical management of a CAF originating from the left coronary artery and connecting to the right atrium, in a patient experiencing angina with a marked left-to-right shunt. The surgical approach involved ligation of the coronary artery and reduction of the aneurysmal portion, resulting in the patient’s uneventful recovery.

Background A coronary artery aneurysm is a rare cardiac anomaly that may be incidentally detected on echocardiography. When associated with a coronary cameral fistula, an aneurysm can become symptomatic. We present a unique case of a giant left circumflex coronary aneurysm with a fistula to the left atrium and a large atrial septal defect causing acute heart failure in a young woman during the peripartum period. Case summary A 32 year-old woman who presented with hypoxia after the delivery of her fourth child was found to have heart failure with severe mitral regurgitation and multiple abnormal intracardiac shunts. Echocardiography showed a large circular structure with Doppler color flow into the left atrium and between the atria. Cardiac computed tomography showed multiple dilated coronary arteries including a left circumflex coronary artery aneurysm measuring >10 cm in diameter with fistulous communication to the left atrium and a large atrial septal defect. A right heart catheterization was performed, and the patient was diagnosed with high-output heart failure. Surgical closure of the coronary cameral fistula was deferred due to the risk of worsening pressure in the coronary aneurysm, and the patient was referred for cardiac transplantation. Discussion This case illustrates severe heart failure as a complication of a giant coronary artery aneurysm with fistulization to the left atrium and subsequent shunting through a large atrial defect. Echocardiography allows for the detection of a coronary aneurysm and shunting, and cardiac computed tomography provides detailed visualization of a coronary cameral fistula. [ABSTRACT FROM AUTHOR]

A 56-year-old female presented to us with rheumatic mitral stenosis with a left atrial clot. We found one coronary cameral fistula on the coronary angiography from the posterior left ventricular branch to the left ventricle. She was taken up for surgical mitral valve replacement and clot removal. A residual coronary fistula may increase the risk of infective endocarditis, especially in the presence of mechanical prosthesis. Henceforth, intra-operatively, we used the methylene blue dye injection as an easy technique to detect and safely close the coronary fistula from inside the left ventricular chamber. She recovered smoothly with a successful outcome. [ABSTRACT FROM AUTHOR]

A 56-year-old African American female was under evaluation for coronary artery disease by a cardiologist due to her complaints of intermittent chest pain. She underwent an outpatient echocardiogram and was found to have an ejection fraction of 20–25% with global left ventricular hypokinesis. Due to this finding along with her ongoing chest pain, she was referred to the emergency department for further evaluation. Her electrocardiogram showed changes suggestive of ischaemia and her cardiac troponins were mildly elevated, so she underwent an urgent cardiac catheterisation. The angiography confirmed the reduced ejection fraction and global left ventricular hypokinesis, but also demonstrated a large coronary cameral fistula (CCF) extending from the first septal branch into the left ventricle. She was then diagnosed with non-ischaemic cardiomyopathy and heart failure with reduced ejection fraction secondary to the CCF. In this report, we illustrate a frequently encountered clinical scenario in which a patient presented with chest pain and EKG findings indicative of ischaemic cardiomyopathy. The patient also had several risk factors for coronary artery disease, however further investigation revealed an alternative diagnosis.

Coronary cameral fistula (CCF) is defined as an abnormal connection between the coronary artery and any cardiac chamber. It usually appears due to abnormal embryogenesis and represents less than 1% of the population. Most CCF cases are asymptomatic, however large CCFs may cause symptoms and complications. We present a case of a young female with symptomatic CCF suspected on echocardiography and confirmed by computed tomography coronary angiography. She was successfully treated surgically with total improvement of symptoms.

We report a rare case with a right-to-left shunt across patent foramen ovale induced by increased blood volume in the right heart structures and severe tricuspid regurgitation which was attributed to a left-to-right shunt via coronary cameral fistulas, resulting in systemic hypoxia without pulmonary hypertension. Right-to-left and left-to-right shunts across patent foramen ovale and coronary cameral fistulas can coexist, potentially worsened by another shunt and vice versa. [ABSTRACT FROM AUTHOR]

Coronary fistulae with cardiac chambers (cameral fistulae) are rare congenital vascular anomalies. Here, we are reporting a case of a 25-year-old male patient who presented with a history of palpitation and chest pain. He was evaluated further and on cardiac multi-slice computed tomography, he was diagnosed to have an extremely rare coronary cameral fistula arising from the left main coronary artery, traversing tortuously between aortic roots anteriorly and left atrium posteriorly, and culminating into superior vena cava just before the cavoatrial junction. Intraoperative complexity was encountered due to the presence of a large left main coronary aneurysm and aneurysmally dilated superior vena cava. Elective surgery was performed on cardiopulmonary bypass with aortic and bicaval (high superior vena cava) cannulation. Cardioplegia delivery was challenging due to the presence of a large fistulous connection between the aortic root and superior vena cava. The patient was operated on successfully for coronary cameral fistula and symptoms resolved.

66yrs old, Male, presented to our hospital with history of low-grade fever of one month duration. Only significant past history was right coronary artery (RCA)stenting done a year ago. Physical examination no localizing signs of fever. Blood culture identified pseudomonas aeruginosa. Electrocardiogram (ECG) showed old inferior wall myocardial infarction changes. Echocardiography (ECHO) detected myocardial abscess along the right atrioventricular groove and vegetation on tricuspid valve. Coronary angiogram showed totally occluded and infected RCA stent with formation of coronary cameral fistula, draining into right atrium. A positron emission tomography (PET) scan and a computed tomography (CT) scan showed increased tracer uptake in RCA stent, peri-stent abscess. Infected stent, artery, and vegetation removed surgically, then graft given to distal RCA. The multi-diagnostic modality helped in identifying this condition early. Timely surgical intervention helped the patient to recover in otherwise life-threatening complication.

The existence of an anomalous connection between any of the cardiac chambers and a major coronary artery is the characteristic feature of coronary cameral fistula. This is a case of an 8-year-old child with a congenital coronary cameral fistula from the left circumflex to the right atrium. The fistula was surgically ligated. The postoperative course was uneventful with a good outcome. [ABSTRACT FROM AUTHOR]

Coronary fistulae with cardiac chambers (cameral fistulae) are rare congenital vascular anomalies. Here, we are reporting a case of a 25-year-old male patient who presented with a history of palpitation and chest pain. He was evaluated further and on cardiac multi-slice computed tomography, he was diagnosed to have an extremely rare coronary cameral fistula arising from the left main coronary artery, traversing tortuously between aortic roots anteriorly and left atrium posteriorly, and culminating into superior vena cava just before the cavoatrial junction. Intraoperative complexity was encountered due to the presence of a large left main coronary aneurysm and aneurysmally dilated superior vena cava. Elective surgery was performed on cardiopulmonary bypass with aortic and bicaval (high superior vena cava) cannulation. Cardioplegia delivery was challenging due to the presence of a large fistulous connection between the aortic root and superior vena cava. The patient was operated on successfully for coronary cameral fistula and symptoms resolved. [ABSTRACT FROM AUTHOR]

Coronary cameral fistulas are rare anomalous connections between coronary circulation and cardiac chambers. Coronary cameral fistulas are often asymptomatic but may cause volume overload on impacted chambers, and also create high velocity turbulent diastolic flow which may predispose patients to endocarditis. This paper presents a unique case of infective endocarditis revealed by intracerebral hemorrhage with a mycotic aneurysm in a patient who was found to have a nonvalvular infective endocarditis located on the mitral anterolateral papillary muscle, at the ventricular site of entrance of a large coronary cameral fistula., Competing Interests: The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2024 The Authors.)

Coronary artery fistulas (CAF) are rare anomalies that pose a significant diagnostic and therapeutic challenge. Most of them originate from the right coronary artery and are congenital. They are often associated with coronary aneurysms. We report the case of a 38-year-old Black man who presented with exertion dyspnea. Transthoracic echocardiography found what was thought to be a bi-atrial hydatid cyst, alongside a right atrial shunt. Cardiac magnetic resonance imaging showed a cystic lesion hypointense on T1 and T2 sequences, located next to the left atrium as well as an aneurysmal circumflex artery shunting in the right atrium. Coronary angiography and computed tomography angiography confirmed the bilobed circumflex saccular aneurysm and CAF. The patient underwent a successful surgery, which consisted of closure of the fistula using two patches. He was discharged after an uneventful postoperative course. Our case report illustrates the diagnostic difficulty of CAF and the importance of multimodal imaging. [ABSTRACT FROM AUTHOR]

Anomalous origin of left anterior descending artery (LAD) from pulmonary artery (ALADCAPA) with dual LAD from left sinus is an extremely rare coronary anomaly. The diagnostic challenge lies in differentiating this from a coronary cameral fistula. Surgical reimplantation of the anomalous LAD is recommended to prevent the risk of myocardial ischaemia and ventricular arrhythmias. [ABSTRACT FROM AUTHOR]

Prevalence of primary coronary cameral fistula (CCF) is extremely rare, especially for CCF with its drainage channel into the left ventricle (LV). We describe a 45‐year‐old male patient with giant aneurysm associated with proximal right coronary artery (RCA), and the distal end of RCA draining into the LV through a fistula, which was discovered by echocardiography. Dual‐source computer tomography revealed only the CCF‐related giant RCA aneurysm. The drainage site of the fistula and the above coexistent abnormality could not be visualized clearly by coronary artery angiography because of deficient contrast medium filling into the aneurysm. The patient underwent surgical resection of the giant aneurysm and occlusion of the fistula in 2015. Finally, the patient accepted another operation to occlude the residual coronary fistula in 2021. [ABSTRACT FROM AUTHOR]

Coronary cameral fistulas (CCFs) are uncommon congenital or acquired anomalies characterized by abnormal connections between a coronary artery and a cardiac chamber. While often asymptomatic and incidentally detected, symptomatic presentations are rare, and symptoms may vary depending on the size and location of the fistula. We present the case of a 67-year-old female with complaints of intermittent typical cardiac chest pain and exertional dyspnea. Further evaluation revealed a CCF originating from the left anterior descending coronary artery and the left ventricle. Additionally, the patient was found to have pulmonary hypertension on right heart catheterization. This case highlights the importance of considering CCF in the differential diagnosis of chest pain, particularly in the presence of atypical symptoms and associated pulmonary hypertension (WHO Group 4). Further research is warranted to elucidate the optimal management strategies for symptomatic CCF, especially in cases complicated by pulmonary hypertension., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Saleh et al.)

Abnormal congenital aorto-cardiac communications (CACC) are a heterogeneous constellation of anomalies that provide an abnormal connection between the aorta and other cardiac chambers or structures, including the atria, ventricles, the main pulmonary artery, and the coronary sinus. The current terminology of CACC has significant errors and shortcomings including inconsistent and interchangeable use of terms of fistula and tunnel and lack of an inclusive classification with practical information on therapeutic management. The aims of this study were threefold: firstly, to perform a concise narrative review of congenital pathologic connections between the aortic root and cardiac chambers which include rupture of congenital sinus of Valsalva aneurysm, aorto-left ventricular and less commonly right ventricular tunnels, coronary cameral fistulas, and aorto-atrial communications; secondly, to investigate the differentiating features of the so-called aorta right atrial tunnel (ARAT), with and without coronary artery take-off from the tunnel, and coronary cameral fistula (CCF) by applying a differential diagnostic assistance toolbox to two groups of patients with ARAT and CCF; and lastly, to propose a practical and inclusive anatomic-therapeutic classification for CACCs. The two main cornerstones of the proposed classification are the type of the connector between the aorta and cardiac chamber (hole versus passage) and the nature of the connecting passage (anatomic versus extra-anatomic). We classified CACCs into three types. Depending on the intramural versus extramural course of the extra-anatomic connecting passage, type 3 is further subdivided into type 3A and type 3B. [ABSTRACT FROM AUTHOR]

Abstract A patient presenting with worsening dyspnea and left‐sided chest pain underwent heart catheterization, found to have a rare connection between the right and left coronary arteries draining into the left ventricle, consistent with dual coronary‐cameral fistula.

Coronary cameral fistulas (CCFs) are rare arteriovenous malformations that may be congenital or acquired. The presentation of CCFs varies from asymptomatic in early age to symptomatic and start of complications upon aging. Although percutaneous closure with embolization can also be done, surgical closure of CCFs is a gold standard of treatment. We present the case of a 20-year-old patient with a fistula connecting right coronary artery and the right atrium, along with aortic valve endocarditis and congestive cardiac failure.

A 40-year-old African American woman presented with dyspnea, orthopnea, weight gain, and ankle edema. She was admitted for acute decompensated heart failure. Coronary angiography revealed coronary cameral fistula. We used multiple imaging modalities to confirm the fistula’s pathway. Her left ventricular systolic function improved after repair of coronary cameral fistula. (Level of Difficulty: Beginner.)

Left atrial myxoma is the common benign tumor of heart. Coronary arteries may supply these tumor. Considering the vascular nature of the tumor, acquired coronary cameral fistula(CCF) can be a possibility postexcision of the left atrial myxoma. Here, we discuss a case of 53-year-old female patient, who developed acquired CCF, following excision of the tumor and the role of transesophageal echocardiography intraoperatively in diagnosis.

Background Acquired coronary cameral fistula is an extremely rare condition that involves an abnormal communication between a coronary artery and a cardiac chamber. It usually occurs after chest trauma or cardiovascular interventions, such as percutaneous coronary intervention (PCI) and is associated with various outcomes, ranging from a stable status to haemodynamic instability. Acquired coronary cameral fistula frequently arises from the right coronary artery and drains generally into the right ventricle. Case summary We report the unusual case of a 56-year-old male patient referred to an invasive cardiology centre for a suspected left anterior descending (LAD) coronary–left ventricular (LV) fistula resulting from a primary PCI for an anterior ST-elevation myocardial infarction. Here, the confirmed LAD–LV fistula was successfully treated by retrograde PCI with covered stent implantation. Clinical and angiographic outcomes were favourable at 1-month follow-up. Discussion Coronary cameral fistula can be a severe complication of primary PCI. Various treatment strategies can be considered based on haemodynamic status and anatomical features. In the case described herein, the use of a retrograde approach led to permanent fistula closure and complete revascularization. [ABSTRACT FROM AUTHOR]

Congenital aneurysmal dilatation of coronary artery with coronary cameral fistula is rare in childhood. We report an even rarer association of congenital right coronary artery aneurysm and right coronary artery to right ventricle fistula with bicuspid pulmonary valve stenosis and an intact ventricular septum in a 3-year-old child. [ABSTRACT FROM AUTHOR]

The present case illustrates cardiac magnetic resonance imaging (MRI) and three-dimensional (3D) printed anatomic model findings of a coronary-cameral fistula (CCF) and double-chambered right ventricle (DCRV). A pregnant woman presented with palpitations and near syncope. A non-contrast cardiac MRI showed CCF connecting to a DCRV. Post-delivery, the patient had a contrast-enhanced MRI and 3D printed anatomic model to better evaluate her aberrant anatomy. • Pregnant patient presented with coronary-cameral fistula (CCF) and double-chambered right ventricle (DCRV) cardiac anomalies. • Patient's anatomy could be explained by alterations in cardiac chamber, coronary artery and cardiac vessel development. • Patient's anatomy could be seen by multiple modalities: echocardiogram, MRI, and cardiac catheterization. • Cardiac MRI and a 3D printed anatomic model were used to better describe =the patient's CCF and DCRV. [ABSTRACT FROM AUTHOR]

We report a case of coronary cameral fistula arising from the left circumflex artery (LCX) draining into the coronary sinus. This 55-year-old male, with no prior symptoms or risk factors, presented with sudden-onset palpitations and sweating. Contrast enhanced computed tomography coronary angiogram as well as conventional coronary angiography revealed a hugely dilated extremely tortuous fistula from the LCX draining into the coronary sinus. This case is unique because of such a giant fistula remained totally asymptomatic till the sixth decade of life and with no perfusion defect on myocardial perfusion imaging.

A 56-year-old African American female was under evaluation for coronary artery disease by a cardiologist due to her complaints of intermittent chest pain. She underwent an outpatient echocardiogram and was found to have an ejection fraction of 20-25% with global left ventricular hypokinesis. Due to this finding along with her ongoing chest pain, she was referred to the emergency department for further evaluation. Her electrocardiogram showed changes suggestive of ischaemia and her cardiac troponins were mildly elevated, so she underwent an urgent cardiac catheterisation. The angiography confirmed the reduced ejection fraction and global left ventricular hypokinesis, but also demonstrated a large coronary cameral fistula (CCF) extending from the first septal branch into the left ventricle. She was then diagnosed with non-ischaemic cardiomyopathy and heart failure with reduced ejection fraction secondary to the CCF. In this report, we illustrate a frequently encountered clinical scenario in which a patient presented with chest pain and EKG findings indicative of ischaemic cardiomyopathy. The patient also had several risk factors for coronary artery disease, however further investigation revealed an alternative diagnosis., Learning Points: A description of rare coronary anomalies adds to the fund of medical knowledge and can guide physicians to make evidence-based decisions regarding its management.Increasing description of coronary cameral fistula will alert clinicians to suspect it as a cause for worsening heart failure and as a treatable cause of non-ischaemic cardiomyopathy., Competing Interests: Conflicts of Interests: The Authors declare that there are no competing interests., (© EFIM 2024.)

Coronary cameral fistula is a rare congenital anomaly and clinical presentation depends on the location of the defect, degree of shunting, and associated complications. We present a case of coronary cameral fistula where segmental analysis by echocardiogram helped us to avoid misdiagnosis as a ventricular septal defect.

Coronary artery fistulae (CAF) are rare congenital or acquired in which a connection forms between one of the coronary arteries and a heart chamber or with other vessels. This paper describes three cases of CAF along with their initial presentation, imaging findings and management. The first case is a rare form of CAF in which the left circumflex coronary artery fistula empty into left ventricle. We discuss the different types of CAF along with their prevalence and the different imaging tools that could be utilized to identify CAF. There is no unifying consensus on treatment strategy for symptomatic fistulae and we proposed a management algorithm that could be used to make a decision for intervention versus observation. We discuss options for intervention- surgical, catheter-based and medical therapy. [ABSTRACT FROM AUTHOR]

We report a case of acquired multiple coronary microfistulas between left anterior descending coronary artery and left ventricle following myocardial infarction (MI), revealed after coronary angioplasty. Acquired coronary cameral fistulas have been described following a variety of interventions including coronary artery bypass surgery, valve replacement, cardiac transplantation, endomyocardial biopsy, septal myectomy, and coronary angioplasty. In addition, prior MI and severe atherosclerosis can also open up the vessels of Wearn and establish a direct communication with the cardiac chambers. The fistulas appeared in our case were small, multiple, and distal and did not produce any symptoms. Immediate appearance of these fistulas following percutaneous revascularization might be alarming. Awareness of this delayed consequence of myocardial ischemia aids in appropriate management. Relevant reports in the literature are briefly discussed.

Coronary Artery Fistula (CAF) is an abnormal communication between the coronary artery and one of the chambers of the heart or any vessel close to the heart. We hereby, describe the possible anomalous connection between coronary arteries and the right atrium and coronary sinus of the heart in a 52 years old male which has been found through coronary angiogram. It is a very rare anomaly as the fistulous communication drains both into the right atrial chamber and also into the coronary sinus and as a result Coronary Arteriovenous Fistula (CAVF) was established. The origin of fistula is usually unilateral involving only one coronary artery either right or left. It is a very rare anomaly as the fistula is bilateral involving both the right and left coronary systems. The anatomy and morphological features of the fistula is very important in deciding the treatment method of CAF. It has been studied that physiology of CAF mimics various heart lesions. In this case where this fistulae that drains into right atrium and coronary sinus (systemic vein) mimics the physiology of an atrial septal defect.

Coronary cameral fistulas (CCFs) are rare arteriovenous malformations that may be congenital or acquired. The presentation of CCFs varies from asymptomatic in early age to symptomatic and start of complications upon aging. Although percutaneous closure with embolization can also be done, surgical closure of CCFs is a gold standard of treatment. We present the case of a 20-year-old patient with a fistula connecting right coronary artery and the right atrium, along with aortic valve endocarditis and congestive cardiac failure. [ABSTRACT FROM AUTHOR]

Coronary cameral fistula (CCF) is defined as an abnormal connection between the coronary artery and any cardiac chamber. It usually appears due to abnormal embryogenesis and represents less than 1% of the population. Most CCF cases are asymptomatic, however large CCFs may cause symptoms and complications. We present a case of a young female with symptomatic CCF suspected on echocardiography and confirmed by computed tomography coronary angiography. She was successfully treated surgically with total improvement of symptoms., Learning Points: Coronary cameral fistula (CCF) is an abnormal communication between the coronary arteries and cardiac chambers. Most fistulas are asymptomatic, however, large CCFs can cause symptoms.CCF can cause angina pectoris due to the coronary steal phenomenon, and may require surgical intervention.Coronary computed tomography angiography is a highly sensitive method for detecting coronary artery fistulas noninvasively., Competing Interests: Conflicts of Interests: The Authors declare that there are no competing interests., (© EFIM 2023.)

Coronary anomalies are found in less than 1% of diagnostic coronary angiograms. The clinical relevance of these anomalies varies from insignificant to potentially lethal. Here, we present a rare case of a 46-year-old male who was previously diagnosed with severe aortic regurgitation with sub-aortic ventricular septal defect with coronary cameral fistula. Coronary angiography and 2-D echocardiography were showing that this fistula was connecting from the left circumflex artery to the left atrium (LA). Intra-operatively, there was no coronary cameral fistula; it was just an anomalous coronary artery arising from the left circumflex artery and ending upon the left atrial wall. This rare entity should be discussed; as in the literature, anomalous coronary in a case of ventricular septal defect with aortic regurgitation has not been reported yet. [ABSTRACT FROM AUTHOR]

A 56-year-old man who had twice previously undergone orthotopic heart transplantation was admitted with dyspnea and heart failure symptoms. A biopsy excluded rejection. Left heart catheterization revealed a coronary cameral fistula. After the patient was given mild diuretics, his condition improved. No significant fistula flow was detected, and he was discharged. Several months later, the patient was readmitted with worsening chest pain and dyspnea. Left ventricular end-diastolic pressure and flow through the fistula were increased. To correct the coronary cameral fistula, we performed a coil embolization without complications. Several months later at follow-up, the patient's symptoms had resolved, and his left ventricular end-diastolic pressure had normalized. We conclude that coronary fistulas may be caused by trauma to the heart during the de-airing process, which may be prevented in the future with the development of safer and more effective de-airing techniques. [ABSTRACT FROM AUTHOR]

Coronary cameral fistula is a rare congenital cardiac abnormality. An 18-year-old boy presented with features of right heart volume overload. Clinical examination was suggestive of hyperdynamic circulation with continuous murmur in precordium. 2D echocardiography showed dilated right coronary artery, and 3D echocardiography added information in tracing the track of the fistula which was consistent with the diagnosis of right coronary cameral fistula draining into the right ventricle. Coronary angiograms revealed an unusually dilated right coronary artery giving the appearance of an 'elephant trunk' and with a fistulous tract into the right ventricle. Considering the higher risks of surgery in such difficult cases, we performed a successful transcatheter closure of the fistula using an Amplatzer vascular plug. [ABSTRACT FROM AUTHOR]

A 7-year-old female child presented with pyrexia of unknown origin. She had received an empirical regimen of antibiotic for possible endocarditis. Evaluation included multiple imaging supports and blood culture. She had left main coronary artery to right atrium coronary cameral fistula, restricted patent ductus arteriosus, vegetation at the right atrial exit of fistula and negative blood culture. Ongoing fever more than 2 weeks, oscillating vegetation in the echo and histopathological evidence of healing vegetation suggested definite diagnosis of infective endocarditis. She was treated successfully by surgical closure of fistula from the right atrial approach. Device closure in this case would have resulted in a large residual cul-de-sac with or without tiny residual high-velocity jets, either being a threat for future enlargement, rupture of the residual aneurysmal sac, thromboembolism, prolonged anticoagulation, and infective endocarditis. [ABSTRACT FROM AUTHOR]