-
Clinical Cardiology Sep 2014Congenital coronary-pulmonary fistulas (CPFs) are commonly unilateral, but bilateral and multilateral fistulas may occur. In multilateral CPFs, the value of a... (Review)
Review
Unilateral and multilateral congenital coronary-pulmonary fistulas in adults: clinical presentation, diagnostic modalities, and management with a brief review of the literature.
BACKGROUND
Congenital coronary-pulmonary fistulas (CPFs) are commonly unilateral, but bilateral and multilateral fistulas may occur. In multilateral CPFs, the value of a multidetector computed tomography (MDCT) imaging technique as an adjuvant to coronary angiography (CAG) is eminent. The purpose of this study was to describe the clinical presentation, diagnostic modalities, and management of coincidentally detected congenital CPFs.
HYPOTHESIS
Unilateral and multilateral coronary-pulmonary fistulas are increasingly detected due to the wide speard application of multidetector computed tomography which might be a supplementary or replacing to conventional coronary angiography.
METHODS
We evaluated 14 adult patients with congenital coronary artery fistulas (CAFs) who were identified from several Dutch cardiology departments.
RESULTS
Fourteen adult patients (5 female and 9 male), with a mean age of 57.5 years (range, 24-80 years) had the following abnormal findings: audible systolic cardiac murmur (n = 4), chronic atrial fibrillation (n = 2), nonsustained ventricular tachycardia (n = 1), and cardiomegaly on chest x-ray (n = 2). Echocardiography revealed normal findings with trivial valvular abnormalities (n = 9), depressed left ventricle systolic function (n = 3), and severe mitral regurgitation and atrial dilatation (n = 2). The findings in the rest of the patients were unremarkable. CAG and MDCT were used as a diagnostic imaging techniques either alone (CAG, n = 6; MDCT, n = 1) or in combination (n = 7). Single modality and multimodality diagnostic methods revealed 22 fistulas including CPFs (n = 15), coronary cameral fistulas terminating into the right (n = 2) and the left atrium (n = 1), and systemic-pulmonary fistulas (n = 4). Of all of the fistulas, 10 were unilateral, 6 were bilateral, and 6 was hexalateral. (13) N-ammonia positron emission tomography-computed tomography was performed in 3 patients revealing decreased myocardial perfusion reserve.
CONCLUSIONS
CAG remains the gold standard for detection of CPFs. An adjuvant technique using MDCT provides full anatomical details of the fistulas.
Topics: Adult; Aged; Aged, 80 and over; Arterio-Arterial Fistula; Coronary Angiography; Coronary Vessel Anomalies; Echocardiography; Electrocardiography, Ambulatory; Embolization, Therapeutic; Female; Humans; Incidental Findings; Ligation; Male; Middle Aged; Multidetector Computed Tomography; Multimodal Imaging; Myocardial Perfusion Imaging; Netherlands; Predictive Value of Tests; Pulmonary Artery; Tomography, Emission-Computed, Single-Photon; Treatment Outcome; Vascular Surgical Procedures; Watchful Waiting; Young Adult
PubMed: 25196980
DOI: 10.1002/clc.22297 -
British Heart Journal Jul 1955
Topics: Aorta; Arterio-Arterial Fistula; Arteriovenous Fistula; Fistula; Humans; Pulmonary Artery
PubMed: 13239935
DOI: 10.1136/hrt.17.3.411 -
Medicine Dec 2021Patients with congenital pulmonary varix are asymptomatic and require no treatment, but the radiological characteristics of a pulmonary varix are similar to those of a...
RATIONALE
Patients with congenital pulmonary varix are asymptomatic and require no treatment, but the radiological characteristics of a pulmonary varix are similar to those of a pulmonary arteriovenous malformation, which requires treatment. Pulmonary angiography is useful for obtaining information about the dynamics of pulmonary blood flow to differentiate a pulmonary varix from a pulmonary arteriovenous malformation for the purpose of treatment planning. Two cases of congenital pulmonary varices that were differentiated from pulmonary arteriovenous malformations based on pulmonary angiography findings are presented.
PATIENT CONCERNS AND DIAGNOSIS
The first patient was an asymptomatic 39-year-old man. Non-contrast-enhanced computed tomography performed as part of the treatment course for pneumonia showed pulmonary arteriovenous malformation in the right lung. Pulmonary angiography was performed and showed that it was a pulmonary varix. The second patient was an asymptomatic 23-year-old woman. As part of her regular health check-up, she underwent plain chest X-ray examination, which showed an abnormal shadow. Non-contrast-enhanced computed tomography was performed, and pulmonary arteriovenous malformation was suspected. However, contrast-enhanced computed tomography findings suggested that the patient had a congenital pulmonary varix rather than a pulmonary arteriovenous malformation. Pulmonary angiography was subsequently performed for diagnosis, and a pulmonary varix was confirmed.
INTERVENTIONS AND OUTCOMES
No treatment was administered to either patient. The first patient was followed up for four years, and the second patient for two years. Both patients had no symptoms or complications during the follow-up period.
LESSONS
Two cases of congenital pulmonary varices were reported. Information about the dynamics of pulmonary blood flow obtained by performing pulmonary angiography was effective in distinguishing between pulmonary arteriovenous malformation and congenital pulmonary varix.
Topics: Adult; Angiography; Arteriovenous Fistula; Arteriovenous Malformations; Female; Humans; Lung; Male; Pulmonary Artery; Pulmonary Veins; Varicose Veins; Young Adult
PubMed: 34941138
DOI: 10.1097/MD.0000000000028340 -
Methodist DeBakey Cardiovascular Journal 2017Coronary artery fistulae are rare abnormalities of the coronary arteries that are usually discovered incidentally on coronary angiogram. Most patients remain...
Coronary artery fistulae are rare abnormalities of the coronary arteries that are usually discovered incidentally on coronary angiogram. Most patients remain asymptomatic, and significant hemodynamic consequences are rarely observed. The following report describes the case of a patient presenting with symptoms of congestive cardiac failure due to multiple coronary artery fistulae.
Topics: Arterio-Arterial Fistula; Computed Tomography Angiography; Coronary Angiography; Coronary Vessel Anomalies; Female; Heart Failure; Hemodynamics; Humans; Middle Aged; Pulmonary Artery
PubMed: 28740588
DOI: 10.14797/mdcj-13-2-78 -
Journal of Vascular Surgery Feb 2022The aim of the study was to summarize epidemiologic data about aortobronchial fistulae and compare outcomes (mortality, recurrence, reoperation) of open, staged, and...
OBJECTIVE
The aim of the study was to summarize epidemiologic data about aortobronchial fistulae and compare outcomes (mortality, recurrence, reoperation) of open, staged, and endovascular repair of aortobronchial fistula.
METHODS
A systematic literature review was conducted to identify eligible studies published between January 1999 and December 2019. The Cochrane Library, PubMed, and Scopus databases were used as search engines. Eligible studies included articles reporting postoperative outcomes (death/follow-up). Literature review revealed only case reports and small case series, and thus, only descriptive data with data heterogeneity were available. The corresponding authors were contacted to provide additional information or outcome updates (recurrence/reoperation/death).
RESULTS
Overall, 214 patients (90 studies) underwent 271 procedures (including redo procedures and staged procedures). Most of the patients were treated by endovascular means (72.42%). Open surgical repair was performed in 21.96% and staged procedures in 5.6%. Aortobronchial fistulae were located most often in the descending thoracic aorta (zone 3 or 4) (64.6%) and in zone 2 (23.8%). Fourteen percent of aortobronchial fistulae developed after thoracic endovascular aneurysm repair. Recurrence or infection occurred in 20% (43) patients. Recurrences were, to some extent, associated with the presence of endoleak. Long-term antibiotic administration (>1 month) was instituted in 63 patients (29.4%), whereas 90 patients (42%) did not receive antibiotics beyond hospitalization. From the remaining 61 patients, 3 received lifelong antibiotics and for 58 patients data were not available. Considering outcomes, the mean follow-up was 25.1 months (0-188 months) and not significantly different among treatments.
LIMITATIONS
Literature review has revealed only case reports and small case series, and thus, only descriptive data were available. Randomized controlled trials are not available due to the rarity of the disease, which significantly decreases the power of the present study. Also, this study reflects significant data heterogeneity due to the nature of the analyzed manuscripts and would benefit from large patient cohort studies that have not been conducted till today.
CONCLUSIONS
Aortobronchial fistula is a complex disease. Endoleaks may be involved in the development and the recurrence process, and they should not be disregarded. Considering major outcomes (length of follow-up), the available treating strategies are equal, and thus, surgeons should feel confident to apply the treatment of their choice, keeping in mind their experience, patient's age, and clinical condition.
Topics: Aorta, Thoracic; Bronchi; Bronchial Fistula; Endovascular Procedures; Humans; Reoperation; Thoracic Surgical Procedures; Tomography, X-Ray Computed; Vascular Fistula
PubMed: 34624495
DOI: 10.1016/j.jvs.2021.08.108 -
Turkish Journal of Medical Sciences Feb 2017Pulmonary arteriovenous malformations (PAVMs) are direct communications between the branches of pulmonary arteries and veins. This study evaluates surgically treated...
BACKGROUND/AIM
Pulmonary arteriovenous malformations (PAVMs) are direct communications between the branches of pulmonary arteries and veins. This study evaluates surgically treated cases of pulmonary arteriovenous malformations.
MATERIALS AND METHODS
We retrospectively examined 41 cases of PAVM that were operated in our clinic between 1995 and 2012. We obtained the clinical, radiological, and surgical data of the patients from their files.
RESULTS
The 41 cases comprised 27 males and 14 females. Their mean age at diagnosis was 39.8 years (range: 9-71). The symptoms were hemoptysis in 28 cases, dyspnea in five, cough in three, and epistaxis in two; three patients were asymptomatic. Twenty-three right and 19 left posterolateral thoracotomies were performed, including one case which was operated bilaterally. Lower lobectomy was performed in 17 patients, lower lobectomy and lingulectomy in two, upper lobectomy in ten, middle lobectomy in two, segmentectomy in seven, and wedge resection in four. Postoperative histopathology was arteriovenous malformation in all cases.
CONCLUSION
PAVMs are rare clinical conditions. Surgery remains the first choice when embolization treatment cannot be performed or is not successful, in symptomatic and complicated patients with PAVM, and/or in cases where the PAVM diagnosis cannot be established.
Topics: Adolescent; Adult; Aged; Arteriovenous Fistula; Arteriovenous Malformations; Child; Female; Humans; Lung; Male; Middle Aged; Pneumonectomy; Postoperative Complications; Pulmonary Artery; Pulmonary Veins; Retrospective Studies; Thoracotomy; Young Adult
PubMed: 28263484
DOI: 10.3906/sag-1509-30 -
Medicine Jan 2019Complex pulmonary arteriovenous fistula (PAVF) is unusual, and even rarer in 2 members of a family. PAVF may not appear on chest X-ray or computed tomography imaging,...
RATIONALE
Complex pulmonary arteriovenous fistula (PAVF) is unusual, and even rarer in 2 members of a family. PAVF may not appear on chest X-ray or computed tomography imaging, especially in asymptomatic patients, and therapy is limited. Herein, PAVFs occurring in a mother and daughter are described, with the current standard methods of diagnosis and treatment of PAVF.
PATIENT CONCERNS
A 34-year-old woman and her 13-year-old daughter presented with light cyanosis of the nail beds but were otherwise asymptomatic, and physical examination was unremarkable. Their arterial oxygen saturation levels were low (80-85%).
DIAGNOSES
Angiography led to a diagnosis of PAVF involving the bilateral lung in both women.
INTERVENTIONS
The combined use of coils with occluder (patent ductus arteriosus, or PDA) to obstruct the fistula.
OUTCOMES
After interventional treatment, the patients' arterial oxygen saturation improved rapidly (90-95%). At 6-month follow-up, the patients' symptoms and oxygen saturation were normal.
LESSONS
PAVF is an autosomal dominant disease. Here, the characteristics of the 2 patients were very similar. Using detachable coils and then a PDA occluder is a highly efficient method for treating complex PAVFs.
Topics: Adolescent; Adult; Arteriovenous Fistula; Diagnosis, Differential; Female; Humans; Nuclear Family; Pulmonary Artery; Pulmonary Veins
PubMed: 30633165
DOI: 10.1097/MD.0000000000013922 -
Thoracic Cancer Jan 2021Self-expandable metallic stent (SEMS) placement is an urgent procedure for patients with malignant central airway stenoses (CASs) and central airway fistulas (CAFs). The...
BACKGROUND
Self-expandable metallic stent (SEMS) placement is an urgent procedure for patients with malignant central airway stenoses (CASs) and central airway fistulas (CAFs). The aim of this study was to determine the outcome and survival after SEMS placement in patients with malignant CASs and CAFs.
METHODS
SEMSs were inserted into 20 patients with malignant CASs and four with malignant CAFs. Hospital records, the modified Medical Research Council dyspnea scale (mMRC) grade, performance status (PS), symptoms, procedure-related complications and survival after placement were retrospectively reviewed.
RESULTS
Spiral Z stents were inserted in nine patients, covered Ultraflex stents in 14, and a bare Ultraflex in one patient. After SEMS placement, 20 patients (83.3%) showed improvement in mMRC grade, 19 (79.2%) showed improvement in PS, and 21 (87.5%) showed improvement in symptoms. There were three patients whose stents migrated out of place, but there were no patients with obstructive granulation, infection, or mucous plugs. Median survival days after stent insertion was 98 days for CAS and 103 days for CAF, and mean survival days was 383 ± 707 days for CAS and 93 ± 33 days for CAF. Two patients with CAS by malignant lymphoma and thymic cancer survived more than six years because they were also treated with efficient therapies. The five-year survival rate after stent insertion was 7.7%.
CONCLUSIONS
SEMS placement for CAS and CAF is associated with improvement in mMRC grade, PS and symptoms in 87.5% of patients. Patients with a malignant CAS are usually terminal, but the possibility of increasing survival rate will become a reality with new efficient therapies.
KEY POINTS
SIGNIFICANT FINDINGS OF THE STUDY: Reasonable clinical outcomes and improved survival of patients following SEMS placement for thoracic malignancy with central airway stenosis and fistula.
WHAT THIS STUDY ADDS
The possibility of increasing survival rate will become a reality with new efficient therapies.
Topics: Aged; Aged, 80 and over; Bronchial Diseases; Female; Fistula; Humans; Male; Middle Aged; Self Expandable Metallic Stents; Treatment Outcome
PubMed: 33179865
DOI: 10.1111/1759-7714.13707 -
Journal of Medical Case Reports Nov 2022Colopleural fistulas are mostly left-sided and related to trauma, Crohn's disease, or gastrointestinal malignancy. However, a diverticular fistula between the colon and...
BACKGROUND
Colopleural fistulas are mostly left-sided and related to trauma, Crohn's disease, or gastrointestinal malignancy. However, a diverticular fistula between the colon and right pleural space has not been reported and is rare considering the liver forms a natural anatomical barrier on this side. Colopleural fistulas often present with respiratory symptoms ranging from mild cough and dyspnea to sepsis from empyema caused by the leakage of gastrointestinal content into the pleural space. Although colopleural fistulas are rare, maintaining low suspicion is pivotal for timely investigation and appropriate surgical planning, particularly in the context of previous intra-abdominal infections or trauma.
CASE PRESENTATION
A 67-year-old Chinese male presenting with prolonged respiratory symptoms was found to have a right-sided colopleural fistula confirmed by computed tomography imaging and a colonoscopy. It was addressed surgically after multidisciplinary consensus was reached, with a right hemicolectomy and repair of the diaphragmatic defect. The patient recovered remarkably well with resolution of respiratory symptoms.
CONCLUSION
Appropriate work-up of a suspected colopleural fistula with radiological and endoscopic investigations to determine anatomy and etiology is crucial. Most cases will require surgical management, and involvement of the respiratory and cardiothoracic teams is important to optimize lung function preoperatively and plan for possible chest complications.
Topics: Male; Humans; Aged; Diverticular Diseases; Fistula; Crohn Disease; Thorax; Colectomy
PubMed: 36435824
DOI: 10.1186/s13256-022-03668-1 -
The Journal of Veterinary Medical... Aug 2021A 24-year-old, Thoroughbred gelding presented with difficulty breathing for a few days and intermittent nose bleeding before dying. At necropsy, the bronchoesophageal...
A 24-year-old, Thoroughbred gelding presented with difficulty breathing for a few days and intermittent nose bleeding before dying. At necropsy, the bronchoesophageal artery and the bronchial artery that flowed into the left anterior lobe were tortuous and dilated, and it was found that dilated tortuous branches of the bronchial artery ran over the dorsal and ventral surfaces of the left anterior lobe. Histopathologically, an anastomosis between a muscular artery and an elastic artery were demonstrated, which were identified as bronchial and pulmonary arteries, respectively. Based on the gross and histopathological findings, a bronchopulmonary artery fistula was diagnosed. To the best of our knowledge, this is the first case report of a pulmonary vascular anastomosis in a horse.
Topics: Animals; Bronchi; Bronchial Arteries; Fistula; Horse Diseases; Horses; Lung; Male; Pulmonary Artery
PubMed: 34108306
DOI: 10.1292/jvms.21-0221