Coronaro-cardiac fistula

Coronaro-cardiac fistula is a rare cardiac anomaly where there is an abnormal communication between a coronary artery and a cardiac chamber or a great blood vessel. This condition can be congenital or acquired, and it represents an unusual form of coronary artery disease. The presence of a coronaro-cardiac fistula can significantly alter the normal flow of blood within the heart, potentially leading to various clinical manifestations, including heart failure, angina, and endocarditis.

Etiology

Coronaro-cardiac fistulas can be classified based on their origin. Congenital fistulas are present at birth and are thought to result from aberrant development of the coronary arteries during fetal life. Acquired fistulas, on the other hand, may develop as a consequence of cardiac surgery, trauma, or infection.

Pathophysiology

The pathophysiology of a coronaro-cardiac fistula involves the diversion of blood from the high-pressure coronary arteries to the lower pressure cardiac chambers or vessels. This results in a left-to-right shunt that can lead to volume overload in the receiving chamber and subsequent cardiac remodeling. Over time, this may impair cardiac function and lead to symptoms of heart failure.

Clinical Presentation

Patients with coronaro-cardiac fistula may be asymptomatic or present with a variety of symptoms depending on the size and location of the fistula. Common symptoms include dyspnea, fatigue, palpitations, and chest pain. A continuous murmur, best heard at the left sternal border, is a characteristic physical finding.

Diagnosis

The diagnosis of coronaro-cardiac fistula typically involves echocardiography, which can visualize the abnormal flow of blood. Cardiac catheterization and coronary angiography are also critical for defining the anatomy of the fistula and planning treatment.

Treatment

The treatment of coronaro-cardiac fistula depends on the size of the fistula and the severity of symptoms. Small, asymptomatic fistulas may require no treatment but should be monitored for changes in size or symptoms. Larger or symptomatic fistulas may require intervention, either through cardiac surgery to close the fistula or through catheter-based techniques.

Prognosis

The prognosis for individuals with coronaro-cardiac fistula varies. Small, asymptomatic fistulas may have a benign course, while larger fistulas associated with significant shunting and symptoms may require intervention to prevent complications.