A Rare case of Coronary A-V Fistula Draining into SVC

Abstract

A Congenital coronary arteriovenous fistula
is a direct communication between a
coronary artery and the lumen of any of
the cardiac chambers, the coronary sinus,
the pulmonary artery, or the superior
vena cava. The number, origin, and
course of the coronary arteries are otherwise
normal. Coronary arteriovenous fistula
is a rare congenital anomaly that is
seen in 0.1 to 0.2 of coronary angiograms.
They are classified into 3 categories
abnormalities of origin, distribution,
and termination. Coronary artery
fistulae are considered to be termination
abnormalities. They are uncommon and
are seen in only 0.1 to 0.2 of coronary
angiograms. In the majority of reported
cases, coronary fistulae were found to
originate from the right coronary artery
(52 of cases) and to drain into the right
ventricle (40 of cases). Fistulae originated
from the circumflex artery in 18 of
cases and drained into the pulmonary
artery in 17 of cases. In the majority of
cases (over 90 of patients), the coronary
fistula results from an abnormal coronary
artery system with aberrant termination
(coronary artery fistula
or coronary-cameral fistula) rather than arteriovenous
fistula. In more than 90 of reported
cases, the fistula terminates in the
right side of the heart (approximately 40 in
the RV, 30 in the RA, and 20 in the PA). It
rarely terminates in the left side of the
heart, but when it does, the majority enter
the left atrium (LA). We present a rare case
of coronary A-V fistula drains into SVC.Our
patient is 42 year old not a known heart
disease presented with class II dyspnea
and palpitation.Clinical examination revealed
continuous murmur over right sternal
border.Echocardiogram showed turbulence
present in LCx origin and its
course.Coronary angiogram and CT angiogram
showed hugely dilated tortuous
left circumflex artery draining into posterior
aspect of superior vena cava.