
==== Front
J Med Case Rep
J Med Case Rep
Journal of Medical Case Reports
1752-1947
BioMed Central London

39300528
4784
10.1186/s13256-024-04784-w
Case Report
Pediatric coronary cameral fistula in a structurally normal heart: a case report and review of the literature
Mortezaeian Hojjat 1
Taheri Maryam 2
http://orcid.org/0000-0001-9813-3298
Anafje Mohsen mohsenanafje@gmail.com

35
Esmaeili Zahra 3
Hassanzadeh Golnar 4
Ebrahimi Pouya 2
1 grid.411746.1 0000 0004 4911 7066 Interventional Research Center, Rajaei Cardiovascular, Medical and Research Institute, IUMS, Tehran, Iran
2 grid.411705.6 0000 0001 0166 0922 Tehran Heart Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
3 grid.411746.1 0000 0004 4911 7066 Cardiogenetic Research Center, Rajaei Cardiovascular Medical and Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, 1995614331 Iran
4 https://ror.org/01c4pz451 grid.411705.6 0000 0001 0166 0922 Ophthalmology Research Center at Tehran University of Medical Sciences, Tehran, Iran
5 https://ror.org/03w04rv71 grid.411746.1 0000 0004 4911 7066 Rajaie Cardiovascular Medical and Research institute, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
20 9 2024
20 9 2024
2024
18 4562 8 2024
26 8 2024
© The Author(s) 2024
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
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.

Keywords

Coronary artery anomalies
Coronary cameral fistula
Coronary angiography
issue-copyright-statement© BioMed Central Ltd., part of Springer Nature 2024
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pmcIntroduction

Coronary cameral fistula (CCF) is a rare congenital anomaly where a coronary artery connects abnormally to a cardiac chamber. Typically arising from embryological abnormalities, CCFs can also result from traumas or surgeries. Congenital coronary anomalies occur in about 1% of the population, with CCFs making up 0.2–0.4% of these cases and appearing in 0.1–0.2% of coronary angiograms [1, 2]. The majority of cases are congenital and solitary, accounting for 0.2–0.4% of all congenital cardiac malformations [3]. These fistulas are often asymptomatic for many years and are frequently diagnosed incidentally during imaging studies [4]. In childhood, asymptomatic cases of CCF are often identified by a continuous heart murmur detected during auscultation. For children older than 3–5 years, elective closure of the fistula is recommended due to the increased risk of complications associated with the condition [5]. In symptomatic cases of CCF, patients may experience manifestations such as angina, exertional dyspnea, syncope, and palpitations. These symptoms arise due to the abnormal blood flow and increased demand on the heart caused by the fistula, which can lead to complications if left untreated [6]. Therapeutic intervention with surgical ligation or transcatheter closure (TCC) is typically performed in patients with symptomatic fistulas or in cases of complications. Percutaneous TCC is preferred because it is less invasive and avoids potential surgical complications. However, surgical closure may be necessary if the vessel is tortuous or if the fistula is large and unsuitable for TCC [7]. TCC of CCF has been advocated as a minimally invasive alternative to surgery [7]. In this study, we report the history of a 5-year-old boy with the diagnosis of coronary cameral fistula, which was treated by an Amplatzer™ duct occluder (ADO).

Case presentation

A 5-year-old Iranian boy presented to the emergency room (ER) with complaints of chest pain and dyspnea on exertion. His medical history revealed multiple similar episodes over the previous 4 months, which had not been evaluated. There was no significant family history of cardiac disease, and his drug history was unremarkable. The patient’s social history did not reveal any notable factors contributing to his condition.

On physical examination, his vital signs were stable and within normal ranges. Heart rate was 90 beats per minute, respiratory rate was 20 breaths per minute, blood pressure was 110/70 mmHg, and oxygen saturation was 98% on room air. No murmurs or abnormal heart sounds were detected during auscultation. His cardiopulmonary examination was normal, with clear lung fields and no signs of respiratory distress. Abdominal examination showed no hepatosplenomegaly, and there were no neurological deficits observed.

Methods

The patient was admitted to the pediatric cardiology ward for further evaluation and monitoring. Initial investigations included serial measurements of troponin levels and other relevant blood tests, which are detailed in Table 1. Notably, the lab results revealed mild anemia with a hemoglobin level of 11 g/dL. All other lab results were within normal reference ranges and did not show any remarkable abnormalities. An electrocardiogram (ECG) was performed, revealing normal sinus rhythm with no ST/T wave changes.Table 1 Laboratory findings of the patient

Test	Result	Reference range	
RBC (106/µL)	4.6	4.2–5.5	
Hemoglobin (g/dL)	11	12–16	
WBC (per µL)	9300	4000–11,000	
MCV (fL)	89	80–99	
Hematocrit (%)	39	37–47	
Platelet (per µL)	210,000	150,000–400,000	
Neutrophils (%)	64	40–75	
Lymphocytes (%)	37.1	20–45	
Eosinophils (%)	4.4	0–6	
MCH (pg/cell)	32	27–31	
MCHC (g/dL)	34	32–36	
Troponin I (first sample)	Negative	Negative	
Lipid profile, coagulation factors, and troponin	
Cholesterol	144	Up to 200	
TG (mg/dL)	91	Up to 150	
LDL (mg/dL)	58	Up to 130	
HDL (mg/dL)	45	 > 45	
Blood sugar (mg/dL)	81	74–106	
LDH (Iu/L)	340	235–470 Iu/L	
K+ (mEq/L)	4.2	3.5–5.3	
Creatinine (mg/dL)	0.4	0.5–1.00	
Urea (mg/dL)	11	13–43	
HbA1C %Hb	5.2	4.8–5.9	
PT (seconds)	11	11–13	
PTT (seconds)	30	25–38	
INR	1.1	1–1.5	
CK-MB	17 u/L	 < 25 u/L	
Troponin I (second sample in 6 hours)	Negative	Negative	
BS blood sugar, CK-MB creatine kinase-MB, Hb hemoglobin, HbA1C glycated hemoglobin, HDL high-density lipoprotein, INR international normalized ratio, K+ potassium, LDH lactate dehydrogenase, LDL low-density lipoprotein, MCV mean corpuscular volume, MCH mean corpuscular hemoglobin, MCHC mean corpuscular hemoglobin concentration, PT prothrombin time, PTT partial thromboplastin time, RBC red blood cell count, TG triglycerides, Urea blood urea, WBC white blood cell count

Transthoracic echocardiography (TTE) was then conducted, demonstrating a dilated left coronary artery (LCA) with a large aneurysm and a small orifice to the right ventricular (RV) body. The RV size and function were normal, and the left ventricular ejection fraction (LVEF) was measured at 55%. To further delineate the anatomy and confirm the diagnosis, cardiac computed tomography angiography (CTA) was performed, which substantiated the findings of a dilated LCA and coronary cameral fistula to the RV (Figs. 1, 2).Fig. 1 (A) and (B) Three-dimensional cardiac computed tomography angiography (CTA) images showing a coronary cameral fistula with a dilated left coronary artery (LCA) and a large aneurysm. Both views (A and B) illustrate the aneurysmal dilation of the LCA, with the arrows indicating the location of the fistula and aneurysm

Fig. 2 Cardiac computed tomography angiography (CTA) image showing a coronary cameral fistula (indicated by the arrow). The CTA highlights the connection between the coronary artery and a cardiac chamber, providing a clear view of the anatomical anomaly

Subsequently, cardiac angiography was conducted, confirming the presence of a dilated LCA and a coronary cameral fistula to the right ventricle. During the procedure, the aneurysm was successfully occluded using two Amplatzer™devices (Fig. 3). Post-procedure angiography of the LCA in the right anterior oblique (RAO) view showed no aneurysmal filling, indicating a successful intervention.Fig. 3 Cardiac angiography:A shows the coronary cameral fistula (indicated by the arrow). B illustrates two coronary cameral fistula orifices to the right ventricular (RV) cavity (indicated by the arrow). C shows the coronary cameral fistula immediately after the use of the Amplatzer™ device (indicated by the arrow). D shows the coronary cameral fistula 2 minutes after using the Amplatzer™ device, with successful occlusion (indicated by the arrow)

Results and follow-up

The day after the angiography, the patient’s symptoms were completely resolved. Physical examination revealed normal heart, respiratory system, and neurological function. A chest x-ray was performed, which was normal (Fig. 4). After 48 hours, the patient was discharged without any complications. Follow-up appointments were scheduled at 1, 3, and 6 months after the procedure, during which time the patient reported no abnormal symptoms or recurrences of chest pain or dyspnea.Fig. 4 Chest x-ray taken 1 day after the procedure, showing no signs of complications. The heart and lungs appear normal, and the Amplatzer™ devices are in place and visible (yellow arrow)

Discussion

CCFs are rare coronary anomalies characterized by abnormal connections between a coronary artery and one of the cardiac chambers. These and abnormal connections, though uncommon, can have significant clinical implications, including the development of heart failure and non-ischaemic ischemic cardiomyopathy, as evidenced by the patient in this report [1]. In the reported case of a 5-year-old boy, the CCF presented with significant hemodynamic consequences, manifesting as chest pain and dyspnea on exertion, which necessitated prompt intervention with transcatheter closure using Amplatzer™ duct occluders.

Previous studies have shown that the majority of CCF cases are asymptomatic and often discovered incidentally during imaging studies conducted for other reasons. However, symptomatic cases, particularly those with hemodynamically significant shunts, may require intervention to prevent complications such as heart failure and ischemic damage [9] Pathophysiologically, coronary artery fistulas, including CCFs, arise from a failure of the normal development of the coronary vasculature, resulting in a direct connection between a branch of a coronary artery and a cardiac chamber, which can lead to various clinical presentations depending on the severity of the left-to-right shunt [10] These fistulae often lead to a “coronary steal phenomenon,” where blood is shunted away from the myocardium, potentially causing myocardial ischemia, particularly during increased myocardial oxygen demand, such as exercise [11].

Diagnostic methods for coronary artery fistulas often begin with noninvasive imaging techniques. TTE is useful for visualizing hemodynamically significant fistulas, while transesophageal echocardiography (TEE) provides detailed information about the origin and insertion point area in adults. Cardiac computed tomography (CT) and magnetic resonance imaging (MRI) offer excellent anatomical delineation, particularly useful for surgical planning [12, 13]. However, coronary angiography remains the gold standard for definitive diagnosis and detailed anatomical assessment of coronary artery fistulas, providing precise information on the size, course, and drainage site of the fistula [12, 14].

The use of three-dimensional echocardiography has improved the accuracy of anatomical characterization, enhancing the pre-procedural assessment and planning for interventional procedures [15].

Treatment options for CCFs vary on the basis of the clinical significance of the condition and patient comorbidities. According to the updated 2023 American Heart Association (AHA)/American college of cardiology (ACC) guidelines, the management of coronary artery fistulas has evolved to incorporate the latest evidence and a more patient-centered approach. For large fistulas, closure, using either transcatheter embolization or surgical closure, is recommended regardless of symptoms. Smaller fistulas should also be managed with these methods if complications such as ventricular dysfunction, angina, or arrhythmias are present. This approach aims to prevent severe complications and improve patient outcomes by ensuring timely and appropriate intervention [16]. The literature further indicates that transcatheter closure (TCC) is often preferred due to its minimally invasive nature. It avoids complications related to surgical interventions, such as surgical stress, bleeding, infections, and inflammatory responses from cardiopulmonary bypass. In cases where TCC is not feasible due to anatomical challenges, surgical repair remains the most effective treatment. This involves the obliteration of the fistula through epicardial and endocardial ligations. The choice of therapy is influenced by the size, location, and complexity of the fistula, as well as the patient’s overall health condition and the presence of comorbid conditions [12, 17]. An innovative stent-assisted coil occlusion technique has also been successfully utilized, providing a promising option for complex cases where traditional methods are not suitable [17].

Complications of untreated CCFs include heart failure, myocardial ischemia, arrhythmias, and endocarditis [11, 18]. The prognosis after treatment is generally favorable, especially with timely intervention. Regular follow-up is essential to monitor for potential recurrence of the fistula or the development of related complications [11]. Continuous follow-up is crucial to monitor for any potential recurrence of the fistula or the emergence of related complications. Moreover, CCFs can lead to increased left ventricular end-diastolic pressure, left ventricular hypertrophy (LVH), congestive heart failure (CHF), atrial fibrillation (AF), ventricular tachyarrhythmias (VT), chronic myocardial ischemia, and myocardial infarction (MI). Hemopericardium can result from the rupture of an associated aneurysm, which is a life-threatening complication [19]. Effective occlusion of CCF can be obtained in more than 90% of cases with the appropriate use of occluder devices, highlighting the importance of careful pre-procedural planning and device selection to minimize the risk of complications [15].

Zenooz et al. [4] emphasize the importance of early diagnosis and intervention for CCFs due to the high prevalence of late symptoms and complications, highlighting the role of CT angiography and conventional angiography in the precise delineation of coronary anomalies [10]. Boyle et al. [9] also support the use of multimodality imaging for the diagnosis of CCFs, noting that advances in noninvasive imaging have improved the detection and management of these anomalies [9]. Furthermore, Wolking et al. [20] highlight the potential for mural thrombosis, rupture, aneurysm formation, and intimal rupture as complications of coronary cameral fistulae, highlighting the importance of careful monitoring and timely intervention [20] Minhas et al. [21] also reported that larger fistulas could cause coronary artery steal, resulting in ischemia of the myocardium perfused by the coronary artery distal to the fistula, and other complications such as cardiac failure, atrial fibrillation, bacterial endocarditis, thrombosis, and embolism [21].

CCFs, though rare, are significant anomalies that can lead to severe cardiovascular issues if not treated properly. This case of a 5-year-old boy underscores the importance of prompt diagnosis and intervention. With advancements in imaging technologies such as three-dimensional echocardiography and CT angiography, the accuracy of diagnosing these anomalies and planning for procedures has greatly improved. Transcatheter closure is now the preferred treatment method due to its less invasive nature and high success rate. Continuous follow-up and diligent monitoring are crucial to prevent and address potential complications such as heart failure, myocardial ischemia, and endocarditis. Effective management of CCFs demands a collaborative approach involving cardiologists, radiologists, and interventional specialists to achieve the best patient outcomes. Similar cases reported in previous literature have been summarized and mentioned in Table 2.Table 2 Literature review of case reports on coronary cameral fistula (CCF)

Author(s) and year	Patient demographics	Presentation and diagnosis	Intervention	Outcome and follow-up	
Velázquez-Castañeda et al. [22]	7-day-old female	Hx: Dehydration, jaundice, heart murmur; maternal substance abuse. PH/E: Stable, regurgitant murmur at mesocardium. Lab: Not specified. Imaging: TTE and CTA (intercoronary communication between LAD and RCA, coronary ectasia)	Conservative management with medications; f/u scheduled	Asymptomatic; no symptoms reported at 6-month f/u	
Moges et al. [23]	5-month-old female	Hx: Labored breathing, bluish lips and extremities. PH/E: Tachycardia, central cyanosis, grade I clubbing. Lab: Hypoglycemia, anemia, positive blood culture for coagulase-negative Staphylococcus. Imaging: TTE and CTA (large CAF involving left main artery draining into LV, secundum ASD, VSD with right to left shunt, tricuspid valve dysplasia)	Managed in ICU for hypoxic spells; fatal outcome due to respiratory arrest	Infant developed cyanotic spells; succumbed to respiratory arrest despite resuscitative efforts	
Srivastava et al. [24]	6-year-old male	Hx: Routine cardiac murmur noted in clinic visits. PH/E: NL HR, soft early diastolic murmur at apex. Lab: Not specified. Imaging: TTE, CT, and coronary angiography (dilated LMCA and LAD, multiple fistulous communications to LV, LV noncompaction)	Conservative management with aspirin; regular f/u	Asymptomatic; no intervention required; stress thallium test negative for ischemia	
Raj et al. [25]	8-year-old female	Hx: Recurrent respiratory tract infection. PH/E: Continuous murmur on auscultation. Lab: Normal blood studies. Imaging: TTE (LCX to RA fistula, dilated LMCA and LCX, dilated RA and RV) and CT angiogram (dilated LMCA with fistulous communication to RA)	Surgical ligation of fistula	Uneventful postoperative course; no residual fistula on f/u echocardiogram at 3 months	
Upadhyay et al. [19]	20-year-old male	Hx: Fever (8 months), dyspnea on exertion. PH/E: Pulse 106/minute, BP 90/40 mmHg on dopamine, and continuous precordial murmur. Lab: Anemia, positive blood culture for fungal growth. Imaging: TTE (dilated LA, LV; severe aortic regurgitation, vegetations, aortic root abscess) and cardiac CT (dilated sinoatrial nodal artery, pulmonary hypertension, heart failure pattern)	AVR and CCF repair after antifungal treatment	Symptom resolution; successful AVR and CCF repair with no postoperative complications	
ASD atrial septal defect, AVR aortic valve replacement, BP blood pressure, CAF coronary artery fistula, CRP C-reactive protein, CTA computed tomography angiography, CTCA coronary computed tomography angiography, CXR chest x-ray, f/u follow-up, Hx history, LAD left anterior descending artery, LCX left circumflex artery, LV left ventricle, LMCA left main coronary artery, NL normal, PH/E physical examination, RA right atrium, RCA right coronary artery, RV right ventricle, TOE transesophageal echocardiography, TTE transthoracic echocardiography, VSD ventricular septal defect, WBC white blood cells

Conclusions

Timely identification of CCFs is essential to prevent severe cardiovascular complications, including heart failure and myocardial ischemia. Advances in imaging techniques, such as three-dimensional echocardiography and CT angiography, have significantly improved diagnostic accuracy and treatment planning. Transcatheter closure has emerged as the preferred treatment modality due to its minimally invasive nature and high success rate, while surgical intervention is reserved for cases where transcatheter closure is not feasible. Regular follow-up and monitoring are crucial to detect and manage potential complications early, such as arrhythmias, myocardial infarction, and endocarditis. A multidisciplinary approach involving cardiologists, radiologists, and interventional specialists is necessary to provide comprehensive care and ensure optimal patient outcomes. Additionally, the use of innovative techniques and devices, such as stent-assisted coil occlusion, offers promising results in treating complex CCF cases where traditional methods pose challenges.

Abbreviations

ADO Amplatzer™ duct occluder

AF Atrial fibrillation

ASD Atrial septal defect

AVR Aortic valve replacement

BP Blood pressure

BS Blood sugar

CAF Coronary artery fistula

CCF Coronary cameral fistula

CHF Congestive heart failure

CK-MB Creatine kinase-MB

CRP C-reactive protein

CTA Computed tomography angiography

CTCA Coronary computed tomography angiography

CXR Chest x-ray

ECG Electrocardiogram

ER Emergency room

FU Follow-up

Hb Hemoglobin

Hb A1C Glycated hemoglobin

HDL High-density lipoprotein

HR Heart rate

ICU Intensive care unit

INR International normalized ratio

LAD Left anterior descending artery

LCA Left coronary artery

LCX Left circumflex artery

LDL Low-density lipoprotein

LDH Lactate dehydrogenase

LMCA Left main coronary artery

LV Left ventricle

LVH Left ventricular hypertrophy

LVEF Left ventricular ejection fraction

MCH Mean corpuscular hemoglobin

MCHC Mean corpuscular hemoglobin concentration

MCV Mean corpuscular volume

MI Myocardial infarction

MRI Magnetic resonance imaging

NL Normal

PT Prothrombin time

PTT Partial thromboplastin time

RA Right atrium

RCA Right coronary artery

RBC Red blood cell count

RV Right ventricle

TCC Transcatheter closure

TEE Transesophageal echocardiography

TG Triglycerides

TOE Transesophageal echocardiography

TTE Transthoracic echocardiography

VT Ventricular tachyarrhythmias

VSD Ventricular septal defect

WBC White blood cell count

Acknowledgements

Not applicable.

Author contributions

MT and PE contributed to the conceptualization, methodology, data collection, investigation, curation, writing of the first draft of the manuscript, and submission. HM and MA contributed to the data collection, curation, supervision, software development, and revision of the final draft of the manuscript. ZE and GH contributed to the data collection and the revision of the manuscript.

Funding

No funds were received for this study.

Data availability

There is no supporting data, and all available information is included in the manuscript.

Declarations

Ethics approval and consent to participate

The study has been reviewed and approved by the Shaheed Rajaei Cardiovascular, Medical and Research’s Ethics Committee. The information provided is anonymized, and the name or characteristics are not mentioned. Therefore, this committee has waived the need for an ethical code. The parent/legal guardian of the patient provided written informed consent on behalf of the patient to participate in this clinical case report. They have been assured that all personal information and medical data will be kept confidential and used solely for research purposes.

Consent for publication

Written informed consent was obtained from the patient’s legal guardian for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

Competing interests

The authors declare no conflicts of interest.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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References

1. Chirumamilla Y Brar A Belal F McDonald P Large coronary cameral fistula to the left ventricle presenting as congestive heart failure Eur J Case Rep Intern Med 2024 10.12890/2024_004364 38715876
Chirumamilla Y, Brar A, Belal F, McDonald P. Large coronary cameral fistula to the left ventricle presenting as congestive heart failure. Eur J Case Rep Intern Med. 2024. 10.12890/2024_004364.38715876
2. Mortezaeian H Tabib A Pouraliakbar H Anafje M Ebrahimi P Soltani P Ventricular septal defect and mitral regurgitation due to penetrating cardiac trauma; a case report and review of literature Arch Acad Emerg Med 2024 12 1 e25 10.22037/aaem.v12i1.2267 38572216
Mortezaeian H, Tabib A, Pouraliakbar H, Anafje M, Ebrahimi P, Soltani P. Ventricular septal defect and mitral regurgitation due to penetrating cardiac trauma; a case report and review of literature. Arch Acad Emerg Med. 2024;12(1): e25. 10.22037/aaem.v12i1.2267.38572216
3. Luong D Weerakkody Y Coronary cameral fistula Radiopaedia.org 2021 Cotham Radiopaedia.org
Luong D, Weerakkody Y. Coronary cameral fistula. In: Radiopaedia.org. Cotham: Radiopaedia.org; 2021.
4. Zenooz NA Habibi R Mammen L Finn JP Gilkeson RC Coronary artery fistulas: CT findings Radiographics 2009 29 3 781 789 10.1148/rg.293085120 19448115
Zenooz NA, Habibi R, Mammen L, Finn JP, Gilkeson RC. Coronary artery fistulas: CT findings. Radiographics. 2009;29(3):781–9. 10.1148/rg.293085120.19448115
5. Challoumas D Pericleous A Dimitrakaki IA Danelatos C Dimitrakakis G Coronary arteriovenous fistulae: a review Int J Angiol 2014 23 1 1 10 10.1055/s-0033-1349162 24940026
Challoumas D, Pericleous A, Dimitrakaki IA, Danelatos C, Dimitrakakis G. Coronary arteriovenous fistulae: a review. Int J Angiol. 2014;23(1):1–10. 10.1055/s-0033-1349162.24940026
6. Armsby LR Keane JF Sherwood MC Forbess JM Perry SB Lock JE Management of coronary artery fistulae J Am Coll Cardiol 2002 39 6 1026 1032 10.1016/S0735-1097(02)01742-4 11897446
Armsby LR, Keane JF, Sherwood MC, Forbess JM, Perry SB, Lock JE. Management of coronary artery fistulae. J Am Coll Cardiol. 2002;39(6):1026–32.11897446
7. Sunkara A Chebrolu LH Chang SM Barker C Coronary artery fistula Methodist Debakey Cardiovasc J 2017 13 2 78 10.14797/mdcj-13-2-78 28740588
Sunkara A, Chebrolu LH, Chang SM, Barker C. Coronary artery fistula. Methodist Debakey Cardiovasc J. 2017;13(2):78.28740588
8. Armsby LR Keane JF Sherwood MC Forbess JM Perry SB Lock JE Management of coronary artery fistulae. Patient selection and results of transcatheter closure J Am Coll Cardiol 2002 39 6 1026 1032 10.1016/S0735-1097(02)01742-4 11897446
Armsby LR, Keane JF, Sherwood MC, Forbess JM, Perry SB, Lock JE. Management of coronary artery fistulae. Patient selection and results of transcatheter closure. J Am Coll Cardiol. 2002;39(6):1026–32.11897446
9. Boyle S Jesuthasan LSB Jenkins C Challa P Ranjan S Dahiya A Coronary-cameral fistula obtuse marginal to left ventricle via anterolateral papillary muscle Circ Cardiovasc Imaging 2019 10.1161/CIRCIMAGING.118.008691 31088151
Boyle S, Jesuthasan LSB, Jenkins C, Challa P, Ranjan S, Dahiya A. Coronary-cameral fistula obtuse marginal to left ventricle via anterolateral papillary muscle. Circ Cardiovasc Imaging. 2019. 10.1161/CIRCIMAGING.118.008691.31088151
10. Zenooz NA Habibi R Mammen L Finn JP Gilkeson RC Coronary artery fistulas: CT findings Radiographics 2009 29 3 781 789 10.1148/rg.293085120 19448115
Zenooz NA, Habibi R, Mammen L, Finn JP, Gilkeson RC. Coronary artery fistulas: CT findings. Radiographics. 2009;29(3):781–9.19448115
11. Challoumas D Pericleous A Dimitrakaki IA Danelatos C Dimitrakakis G Coronary arteriovenous fistulae: a review Int J Angiol 2014 23 1 10 10.1055/s-0033-1349162 24940026
Challoumas D, Pericleous A, Dimitrakaki IA, Danelatos C, Dimitrakakis G. Coronary arteriovenous fistulae: a review. Int J Angiol. 2014;23:1–10.24940026
12. Coronary Artery Fistula—StatPearls—NCBI Bookshelf Rao SS, Agasthi P. Coronary Artery Fistula. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024. https://www.ncbi.nlm.nih.gov/books/NBK559191/. Accessed 5 Jun 2023.
13. Sunkara A, Chebrolu LH, Min Chang S, Barker C. Houstonmethodist.org/debakey-journal. 2017.
14. Armsby LR Keane JF Sherwood MC Forbess JM Perry SB Lock JE Management of coronary artery fistulae patient selection and results of transcatheter closure ACC Current J Rev 2002 10.1016/S1062-1458(02)00844-9
Armsby LR, Keane JF, Sherwood MC, Forbess JM, Perry SB, Lock JE. Management of coronary artery fistulae patient selection and results of transcatheter closure. ACC Current J Rev. 2002. 10.1016/S1062-1458(02)00844-9.
15. Carminati M Giugno L Chessa M Butera G Piazza L Bussadori C Coronary-cameral fistulas: indications and methods for closure EuroIntervention 2016 1 12 X28 30 10.4244/EIJV12SXA6
Carminati M, Giugno L, Chessa M, Butera G, Piazza L, Bussadori C. Coronary-cameral fistulas: indications and methods for closure. EuroIntervention. 2016;1(12):X28-30.
16. Virani SS Newby LK Arnold SV Bittner V Brewer LPC Demeter SH 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA guideline for the management of patients with chronic coronary disease: a report of the American heart association/American college of cardiology joint committee on clinical practice guidelines J Am Coll Cardiol 2023 82 9 833 955 10.1016/j.jacc.2023.04.003 37480922
Virani SS, Newby LK, Arnold SV, Bittner V, Brewer LPC, Demeter SH, et al. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA guideline for the management of patients with chronic coronary disease: a report of the American heart association/American college of cardiology joint committee on clinical practice guidelines. J Am Coll Cardiol. 2023;82(9):833–955.37480922
17. Buzaev IV Plechev VV Khalikova G Khabirova K Nikolaeva IE Onorato EM Case report: coil occlusion of two congenital coronary cameral fistulas connecting right and left circumflex arteries to the right ventricle: an innovative stent-assisted technique Front Cardiovasc Med 2021 10.3389/fcvm.2021.769235 35155596
Buzaev IV, Plechev VV, Khalikova G, Khabirova K, Nikolaeva IE, Onorato EM. Case report: coil occlusion of two congenital coronary cameral fistulas connecting right and left circumflex arteries to the right ventricle: an innovative stent-assisted technique. Front Cardiovasc Med. 2021. 10.3389/fcvm.2021.769235.35155596
18. How WJ Luckie M Bratis K Hasan R Malik N Evolving consequences of right coronary artery to right atrium: coronary cameral fistula—a case report Eur Heart J Case Rep 2024 10.1093/ehjcr/ytae207 38715625
How WJ, Luckie M, Bratis K, Hasan R, Malik N. Evolving consequences of right coronary artery to right atrium: coronary cameral fistula—a case report. Eur Heart J Case Rep. 2024. 10.1093/ehjcr/ytae207.38715625
19. Upadhyay R Gargava A Prabhu V Sarkar M Ramteke JH Coronary cameral fistula and its complications: a case report Ann Card Anaesth 2020 23 4 496 498 10.4103/aca.ACA_140_19 33109810
Upadhyay R, Gargava A, Prabhu V, Sarkar M, Ramteke JH. Coronary cameral fistula and its complications: a case report. Ann Card Anaesth. 2020;23(4):496–8.33109810
20. Wolking S Palmer C Smith T Truong VT Mazur W Rosse C Coronary cameral fistula from left circumflex artery to left atrium identified by three-dimensional transesophageal echocardiography CASE 2020 4 5 365 368 10.1016/j.case.2020.05.013 33117930
Wolking S, Palmer C, Smith T, Truong VT, Mazur W, Rosse C, et al. Coronary cameral fistula from left circumflex artery to left atrium identified by three-dimensional transesophageal echocardiography. CASE. 2020;4(5):365–8.33117930
21. Minhas AMK Ul Haq E Awan AAY Khan AA Qureshi G Balakrishna P Coronary-cameral fistula connecting the left anterior descending artery and the first obtuse marginal artery to the left ventricle: a rare finding Case Rep Cardiol 2017 2017 8071281 28194284
Minhas AMK, Ul Haq E, Awan AAY, Khan AA, Qureshi G, Balakrishna P. Coronary-cameral fistula connecting the left anterior descending artery and the first obtuse marginal artery to the left ventricle: a rare finding. Case Rep Cardiol. 2017;2017:8071281.28194284
22. Velázquez-Castañeda R De La Puente-Tawil I Molina-Castillo S Proaño-Bernal L Rodríguez-Salazar MA Masso-Bueso S Coronary-cameral fistula in an infant patient: an incidental diagnosis Clin Case Rep 2023 10.1002/ccr3.8172 38028060
Velázquez-Castañeda R, De La Puente-Tawil I, Molina-Castillo S, Proaño-Bernal L, Rodríguez-Salazar MA, Masso-Bueso S, et al. Coronary-cameral fistula in an infant patient: an incidental diagnosis. Clin Case Rep. 2023. 10.1002/ccr3.8172.38028060
23. Moges T Ahmed H Gisila A Large cameral coronary artery fistula in a 5 months old infant with unusual presentation and fatal outcome: -case report BMC Pediatr 2023 10.1186/s12887-023-04196-7 37543567
Moges T, Ahmed H, Gisila A. Large cameral coronary artery fistula in a 5 months old infant with unusual presentation and fatal outcome: -case report. BMC Pediatr. 2023. 10.1186/s12887-023-04196-7.37543567
24. Srivastava R Azad S Radhakrishnan S Multiple diffuse coronary cameral fistulas from the left anterior descending artery and right coronary artery to both the right and left ventricle associated with left ventricular noncompaction: a rare combination Ann Pediatr Cardiol 2020 13 2 171 173 10.4103/apc.APC_37_19 32641895
Srivastava R, Azad S, Radhakrishnan S. Multiple diffuse coronary cameral fistulas from the left anterior descending artery and right coronary artery to both the right and left ventricle associated with left ventricular noncompaction: a rare combination. Ann Pediatr Cardiol. 2020;13(2):171–3.32641895
25. Raj LS Anjusha M Arathy RS Coronary cameral fistula: a rare entity Nurs Midwifery Res J 2023 19 1 54 60 10.1177/0974150X221150566
Raj LS, Anjusha M, Arathy RS. Coronary cameral fistula: a rare entity. Nurs Midwifery Res J. 2023;19(1):54–60.
