Authors

• Mario Udovičić — University Hospital Dubrava, Zagreb, Hrvatska — ORCID: 0000-0001-9912-2179
• Mira Stipčević — University Hospital Dubrava, Zagreb, Hrvatska — ORCID: 0000-0003-4351-1102
• Hrvoje Falak — University Hospital Dubrava, Zagreb, Hrvatska — ORCID: 0000-0002-6502-683X
• Aleksandar Blivajs — University Hospital Dubrava, Zagreb, Hrvatska — ORCID: 0000-0003-3404-3837
• Ivana Jurin — University Hospital Dubrava, Zagreb, Hrvatska — ORCID: 0000-0002-2637-9691
• Davor Barić — University Hospital Dubrava, Zagreb, Hrvatska — ORCID: 0000-0001-5955-0275
• Ognjen Čančarević — University Hospital Dubrava, Zagreb, Hrvatska — ORCID: 0000-0002-1285-8042

Keywords

coronary-cameral fistula, endomyocardial biopsy, heart transplantation

DOI

Full Text

**Introduction:** Coronary-cameral fistulae (CCF) are infrequent anomalies which are in general incidentally found during diagnostic coronary angiography. The iatrogenic fistulas are secondary to non-surgical interventions (endomyocardial biopsy (EMB), permanent pacing and ICD leads) or cardiac surgical procedures. (1, 2) Cardiac transplantation is an effective therapy for end-stage heart failure, with allograft rejection as a common problem after transplant. Thus, EMBs still remain the gold standard for its surveillance. **Case report:** We present a case of a 43-years-old-male patient with dilatative cardiomyopathy who underwent an orthotropic, highly urgent heart transplantation in January 2012. The postprocedural recovery was complicated by a massive tricuspid regurgitation that required a tricuspid valve repair. The rest of the first year was uneventful, and the patient underwent 8 regular EMBs, which revealed no signs of cardiac allograft rejection. On a routine follow up angiogram one year after the heart transplantation a CCF between the right coronary artery and right ventricle was detected. Right-sided pressures were normal and there was no significant step-up in blood oxygen saturations from the right atrium to the right ventricle or pulmonary artery, so a conservative approach was chosen. Three years later the patient remains asymptomatic, with normal right sided pressures and cardiac output. **Conclusion:** We hypothesize that the fistula in this patient developed during one of these EMBs. Prevalence of a CCFs is more common in the transplant population compared with the general population (5%–8% vs 0.2%) due to repetitive EMB. Like in this case, CCFs are mostly asymptomatic, with a tendency to spontaneously resolve and have a benign clinical outcome, and only seldom require intervention.

Literature

1. Said SA, Schiphorst RH, Derksen R, Wagenaar L. Coronary-cameral fistulas in adults (first of two parts). World J Cardiol. 2013;5(9):329–36. https://doi.org/10.4330/wjc.v5.i9.329
2. Said SA, Schiphorst RH, Derksen R, Wagenaar L. Coronary-cameral fistulas in adults (second of two parts). World J Cardiol. 2013;5(12):484–94. https://doi.org/10.4330/wjc.v5.i12.484