Abstract
Coronary artery fistulae (CAF) are rare congenital anomalies and reported to have an incidence of 0.1-0.2% of all coronary angiograms. An association between fistulae and nonatherosclerotic coronary artery aneurysms is even more rare. In childhood, patients are mostly asymptomatic; however, patients older than 20 years old may present with signs of infective endocarditis, myocardial ischemia, congestive heart failure, and aneurysm rupture. CAF are typically identified by coronary angiography; however, there are some limited studies showing that transesophageal echocardiography (TEE) can also be useful in identifying CAF. Here we report two cases of endocarditis secondary to congenital coronary artery fistulae draining into either a cardiac cavity or a coronary sinus, which were detected by TEE. Vegetations were found at the site of the fistulae drainage. Management for young patients is either percutaneous or surgical intervention. For elderly patients with multiple comorbidities, conservative treatment is another option. In these two cases, treating endocarditis with proper antibiotics and supportive treatment, the patients' conditions improved significantly.
References
May 1, 1979·Circulation·R R LiberthsonF H Levine
Jul 1, 1992·Journal of the American College of Cardiology·S B PerryJ E Lock
Oct 1, 1981·Annals of Surgery·J E LoweD C Sabiston
Jun 1, 1995·Catheterization and Cardiovascular Diagnosis·M VavuranakisH Boudoulas
Jan 5, 1995·The New England Journal of Medicine·D T Durack
Jul 1, 1993·British Heart Journal·P J GiannoccaroK L Chan
Sep 1, 1993·British Heart Journal·M L Ong
Jan 1, 1996·Mayo Clinic Proceedings·W O HarrisD R Holmes
Jul 1, 1996·Cardiology·T CarrelM Turina
Apr 1, 1997·Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography·J AlmeidaM R Gomes
Oct 5, 1995·Echocardiography·G A Dodds, D T Durack
Jun 22, 2000·Heart·R O NetzerA Cerny
Sep 22, 2001·The Annals of Thoracic Surgery·A OommanM R Girinath
Jul 23, 2002·The American Journal of Medicine·Antonio VitarelliEttore Squillaci
Feb 27, 2003·The International Journal of Cardiovascular Imaging·Abdullah DoganOmer Gedikli
May 18, 2004·Heart·A Evangelista, M T Gonzalez-Alujas
Jul 21, 2004·International Journal of Cardiology·K M Krishnamoorthy, S Rao
Dec 6, 2005·Journal of Cardiothoracic and Vascular Anesthesia·Ryoji IidaSetsuro Ogawa
Dec 13, 2006·Clinical Research in Cardiology : Official Journal of the German Cardiac Society·A OpitzW Moshage
Feb 3, 2007·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Elisabetta LapennaOttavio Alfieri
Aug 3, 2007·Interactive Cardiovascular and Thoracic Surgery·Sebastian PagniJoseph S Abraham
Nov 30, 2007·Clinical Research in Cardiology : Official Journal of the German Cardiac Society·Hubert GuflerAxel Schmermund
Mar 20, 2008·Anesthesia and Analgesia·Toshiyuki SawaiToshiaki Minami
Jul 29, 2009·Archives of Internal Medicine·Elisabeth Botelho-NeversDidier Raoult
Nov 16, 2010·Echocardiography·Masayoshi KimuraHiroaki Matsubara
May 18, 2013·Korean Circulation Journal·Dae Sung AhnRak Kyeong Choi
Nov 5, 2014·Echocardiography·Demet Menekse GeredeCetin Erol