A Novel Hybrid Approach to Correct a Giant Aneurysmal Coronary Artery Fistula in An Adult Male Patient
Presented During:
Saturday, May 6, 2023: 5:00PM - Tuesday, May 9, 2023: 5:00PM
Los Angeles Convention Center
Posted Room Name:
ePoster Area, Exhibit Hall
Abstract No:
6360
Submission Type:
Cardiothoracic Resident Case Report Competition
Authors:
Muhammed Mashat (1), Osama Elkhateeb (2), Simon Jackson (2), Robert Chen (3), Wael Sumaya (2), David Horne (1)
Institutions:
(1) Division of Cardiac Surgery, Dalhousie University, Halifax, Canada, (2) Division of Cardiology, Dalhousie University, Halifax, Canada, (3) Division of Pediatric Cardiology, Dalhousie University, Halifax, Canada
Submitting Author:
Muhammed Mashat
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Division of Cardiac Surgery, Dalhousie University
Division of Cardiac Surgery, Dalhousie University
Co-Author(s):
Osama Elkhateeb
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Division of Cardiology, Dalhousie University
Division of Cardiology, Dalhousie University
Simon Jackson
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Division of Cardiology, Dalhousie University
Division of Cardiology, Dalhousie University
Robert Chen
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Division of Pediatric Cardiology, Dalhousie University
Division of Pediatric Cardiology, Dalhousie University
Wael Sumaya
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Division of Cardiology, Dalhousie University
Division of Cardiology, Dalhousie University
David Horne
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Division of Cardiac Surgery, Dalhousie University
Division of Cardiac Surgery, Dalhousie University
Presenting Author:
Muhammed Mashat
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Abstract:
A 37-year-old male presented with supra-ventricular tachycardia, exercise intolerance and lower limb edema. He reported a 2-year history of dyspnea and palpitations with signs of SVC-Syndrome. Computed tomography angiography (CTA) showed a gigantic 15cm fistula aneurysm caused almost complete obstruction of the superior vena cava (SVC), inferior vena cava (IVC), right pulmonary veins and right pulmonary artery (RPA).
The Achilles heel of surgical coronary arteriovenous fistula (CAVF) ligation is myocardial protection. A hybrid approach was utilized to overcome this issue. The fistula was occluded using a percutaneous plug device and subsequently resecting the aneurysm on cardio-pulmonary bypass (in order to ensure adequate myocardial protection). Using a telescoping technique, the 14mm plug was deployed proximal to the fistula aneurysm, angiographically occluding flow through the fistula and aneurysm.
Subsequently, sternotomy was performed on cardiopulmonary bypass (CPB) via peripheral cannulation as the aneurysm was adjacent to the sternum. Successful antegrade cardioplegic arrest occurred without the need to manually occlude the fistula (plug resistance to flow). The fistula aneurysm was opened between the SVC and aorta. All accessible aneurysmal free wall tissue was resected. The fistula inlet and outlet were identified and primarily closed. The patient was weaned off CPB with normal biventricular function.
The patient was discharged on warfarin and ASA for embolic prophylaxis. Eight-month postoperative CTA showed resolution of all obstruction and normalization of heart size. The patient was completely asymptomatic at follow up with no further palpitations.
The Achilles heel of surgical coronary arteriovenous fistula (CAVF) ligation is myocardial protection. A hybrid approach was utilized to overcome this issue. The fistula was occluded using a percutaneous plug device and subsequently resecting the aneurysm on cardio-pulmonary bypass (in order to ensure adequate myocardial protection). Using a telescoping technique, the 14mm plug was deployed proximal to the fistula aneurysm, angiographically occluding flow through the fistula and aneurysm.
Subsequently, sternotomy was performed on cardiopulmonary bypass (CPB) via peripheral cannulation as the aneurysm was adjacent to the sternum. Successful antegrade cardioplegic arrest occurred without the need to manually occlude the fistula (plug resistance to flow). The fistula aneurysm was opened between the SVC and aorta. All accessible aneurysmal free wall tissue was resected. The fistula inlet and outlet were identified and primarily closed. The patient was weaned off CPB with normal biventricular function.
The patient was discharged on warfarin and ASA for embolic prophylaxis. Eight-month postoperative CTA showed resolution of all obstruction and normalization of heart size. The patient was completely asymptomatic at follow up with no further palpitations.
Category:
Congenital
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