Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 110109

AbstractCase ReportDiscussionConclusionReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"

Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Case report
Year : 2022 | Month : November | Volume : 16 | Issue : 11 | Page : OD10 - OD12 Full Version

Coronary Cameral Fistula

Published: November 1, 2022 | DOI:
Nirmal Kumar Mohanty, Bijay Kumar Dash, Chhabi Satpathy, Satya Narayan Routray, Satyasarathi Jena

1. Associate Professor, Department of Cardiology, Srirama Chandra Bhanja Medical College, Cuttack, Odisha, India. 2. Assistant Professor, Department of Cardiology, Srirama Chandra Bhanja Medical College, Cuttack, Odisha, India. 3. Associate Professor, Department of Cardiology, Srirama Chandra Bhanja Medical College, Cuttack, Odisha, India. 4. Professor, Department of Cardiology, Srirama Chandra Bhanja Medical College, Cuttack, Odisha, India. 5. Senior Resident, Department of Cardiology, Srirama Chandra Bhanja Medical College, Cuttack, Odisha, India.

Correspondence Address :
Dr. Satyasarathi Jena,
Senior Resident, Department of Cardiology, Srirama Chandra Bhanja Medical College, Cuttack, Odisha, India.


Coronary Cameral Fistulas (CCFs) are rare arteriovenous malformations, defined as a connection between a coronary artery and a cardiac chamber or any segment of the systemic or pulmonary circulation. These may be congenital or acquired, and show a low incidence in both angiographic studies, and the general population. The presentation of CCFs varies depending upon their size and location. These can be majorly asymptomatic or show symptoms and complications like congestive heart failure, myocardial infarction, and bacterial endocarditis. Although percutaneous closure with embolisation can be done, surgical closure of CCF is a gold standard of treatment. The authors reported a case of a 57-year-old male patient who presented with exertional chest pain and dyspnoea. Coronary angiography revealed the presence of dilated tortuous Left Main Coronary Artery (LMCA), Left Anterior Descending artery (LAD), Left Circumflex artery (LCX) and CCF between LAD to Right Ventricle (RV), Obtuse Marginal (OM) to RV and Posterior Left ventricular Branch (PLB) to RV. No significant obstructive coronary artery disease was present. Coronary artery calcium score was 15. The patient was managed conservatively with antiplatelets, statin, and heparin and responded well to the treatment.


Congestive heart failure, Coronary angiography, Myocardial infarction, Right ventricle

Case Report

A 57-year-old male diabetic, non hypertensive, chronic smoker patient presented with exertional chest pain and breathlessness of three days duration in the Cardiology Outpatient Department (OPD). He had one episode of syncope during this period, which lasted for a few seconds with spontaneous and complete recovery. Chest pain was not associated with orthopnoea, Paroxysmal Nocturnal Dyspnoea (PND), palpitation or swelling of face or legs. The patient had type 2 diabetes with good glycemic control (Glycated hemoglobin (HbA1c) 6.9%) and was on oral antidiabetic drugs since 2008.

On examination, the pulse rate was 58 beats per minute (bpm), blood pressure was 110/70 mmHg. All peripheral pulsations were well felt. Heart sounds were normal. There was an ejection systolic murmur of grade was II/VI in pulmonary area. Electrocardiogram (ECG) showed sinus bradycardia with ST depression in inferior and lateral leads (LII, LIII, augmented Vector Foot and augmented Vector Left (aVL), LI, V4 to V6). Echocardiography revealed the presence of mildly dilated Right Atrium (RA) and Right Ventricle (RV), ostium secundum-Atrial Septal Defect (os-ASD) of 7 mm size with a left to right shunt, interatrial septal aneurysm, mild Pulmonary Arterial Hypertension (PAH) with Tricuspid Regurgitation (TR). No Regional Wall Motion Abnormality (RWMA) was detected. Troponin-I was raised to nearly twice the upper limit of normal. A clinical diagnosis of Non ST Elevation Myocardial Infarction (NSTEMI) was made and the patient was managed with aspirin 150 mg daily, clopidogrel 75 mg daily, atorvastatin 40 mg daily and heparin (fondaparinux)-2.5 mg subcutaneous daily.

Elective coronary angiography was done on the third day of admission, which showed dilated Left Main Coronary Artery (LMCA) and dilated tortuous Left Anterior Descending (LAD) and Left Circumflex Artery (LCX) with fistulous connection between LAD and RV, Obtuse Marginal (OM1) and RV and Posterior Left ventricular Branch (PLB) and RV. Right Coronary Artery (RCA) was only mildly dilated (Table/Fig 1),(Table/Fig 2),[(Table/Fig 3). For better delineation of coronary anatomy, CT-coronary angiography was done. This showed dilated LMCA, dilated tortuous LAD and LCX and their branches. LAD was divided into two nearly similarly calibre anterior (diagonals) branch with a fistulous connection with posterior aspect of RV. A thin communication between PLB and adjacent posterior aspect of RV was seen, suggestive of Coronary Cameral Fistula (CCF) (Table/Fig 4),(Table/Fig 5). LA and RA appeared dilated. Main pulmonary artery was dilated. A saccular out pouching of interatrial septum from LA to RA was seen (aneurysm). A small ASD was also seen. Coronary artery calcium score was 15 (mild degree of coronary artery disease). The patient was discharged three days later, on dual antiplatelet therapy with aspirin and clopidogrel as well as statin and Angiotensin-converting Enzyme (ACE) inhibitors. At 1 month follow-up, he remained asymptomatic.


Coronary artery anomalies include anomalies at the origin, during its course and at the site of termination. Fistulae result from its abnormal communication at the site of termination. Broadly, they are classified as Coronary Arterio-venous Fistula (CAVF) when the communication is between a coronary artery or its branches and any part of the systemic or pulmonary vasculature. Coronary cameral fistula is the abnormal communication between a coronary artery and any cardiac chamber (1). In this case, all three major coronary arteries were involved and were draining to the right ventricle, the most common chamber to be involved (1).

The pathophysiology of fistula relates to the amount of blood flowing through it and its pressure gradient. Myocardial ischaemia may be due to decreased flow of blood through the coronary segment distal to the site of fistulous connection due to coronary steal phenomenon. If fistulae are long and multiple, the intracoronary diastolic perfusion pressure could drop below the critical level and during physical activity, leads to increased myocardial oxygen demand causing myocardial ischaemia (2).

Clinical presentation is dependent on the haemodynamic status of the anomaly. Factors like size the fistula, the resistance of the receiving chamber and myocardial ischemia influence the clinical outcome (3). Most fistulae are small and clinically silent. However, common symptoms are exertional dyspnoea, fatigue, angina pain and sometimes congestive heart failure (4). Clinically the cardiovascular examination findings are unremarkable in presence of haemodynamically insignificant fistula. The mechanism of symptoms is due to coronary steal phenomenon and diastolic overload (5),(6).

Volume overload of cardiac chambers may cause congestive heart failure and arrhythmias. Other complications, like, intravascular thrombosis, infective endocarditis may occur (7). The present patient had presented with exertional chest pain with dyspnoea. Though coronary angiography showed CCF involving all three major coronary artery branches, there was no significant obstructive lesion. So the anginal pain could be due to coronary steal phenomenon, which is due to the diversion of blood through the fistulous tract causing myocardial ischemia distal to it. In a study by Wilde P and Watt I, 57.4% were asymptomatic, 24.2% had dyspnoea and 18.7% with chest pain (8). Said SA et al., showed the symptoms of fistula draining to left ventricle could be similar to the signs and symptom of aortic regurgitation (7).

Chest X-ray and Electrocardiography (ECG) changes and even echocardiology may not be of much help in the diagnosis of coronary artery fistula. No specific ECG changes point towards a coronary fistula. Chest radiographs may show cardiomegaly in the presence of significant shunt flow and ECG may reveal the effect of volume overload in larger fistulas. But these are non specific. Echocardiography may only detect dilated coronary artery ostium, not the entire course of the coronary arteries. Intraventricular turbulence may sometimes raise a suspicion of fistulous tract, which can be confirmed by an angiographic study (9).

Coronary angiography establishes the diagnosis of coronary artery fistula. In addition, the severity of atherosclerotic coronary artery disease is also simultaneously diagnosed. Presently, Multidetector Cardiac Computed Tomography (MDCT) is widely used as it is non invasive and it provides three dimensional visualisations making better delineation of coronary anatomy. Lim JJ et al., have shown MDCT to be better in detecting coronary anomalies than traditional CT (10).

Treatment of coronary cameral fistula depends on its hemodynamic significance. Those fistulae being clinically silent without other coexisting abnormalities do not require further treatment. Various treatment options include surgical or catheter closure. Surgery is associated with low mortality and morbidity. Most of the cases described in past, concern the surgical correction of primary coronary cameral fistula of congenital aetiology (11),(12).

Transcatheter closure has become the method of choice though surgical intervention gives good result (13). Percutaneous techniques like interlocking detachable coils, detachable balloons, polyvinyl alcohol foam and amplatzer duct occluder are other treatment options. Device closure is having its own complications like myocardial infarction and migration of closure devices to extracoronary vascular structures or elsewhere within coronary branches (14).

More recently, Yu X et al., (15) described the spontaneous closure of a secondary RCA-RV fistula, and Mertens A et al., (16) reported the case of an acquired LAD-RV fistula treated with coil embolization. The index case was reviewed at the multidisciplinary team meeting by interventional cardiologist, cardiothoracic surgeon and radiologist and was concluded that serial imaging with annual echocardiography and regular clinical review would be the best approach for the patient and that there was no current indication for invasive management.


Coronary cameral fistula, mostly an incidental finding while doing coronary angiography is many a times asymptomatic. Now-a-days, it is detected while doing CT angiography for the diagnosis to ‘rule out’ coronary artery disease. Serial follow-up for asymptomatic CCF is required and definite therapeutic intervention either with surgery or catheter based techniques is required for symptomatic fistulae. Its association with ostium secundum ASD is very rare as in the present case. CCF needs serial follow-up and treatment when symptoms of myocardial ischemia or congestive cardiac failure warrants active intervention.


Sagar D, Hernandez A, Heimowitz T. Coronary artery-Left ventricle fistula: A case report of a rare connection error! Cureus. 2015;7(4):e266. PMID: 26180690 PMCID: PMC4494526. Doi: 10.7759/cureus.266. [crossref] [PubMed]
Heper G, Kose S. Increased myocardial ischemia during nitrate therapy: Caused by multiple coronary artery-left ventricle fistulae? Tex Heart Inst J. 2005;32(1):50- 52. PMC555822.
Majidi M, Shahzamani M, Mirhoseini M. Clinical features of coronary artery fistula. J Tehran Heart Cent. 2011;6(3):158-62.
Kugelmass AD, Manning WJ, Piana RN, Weintraub RM, Baim DS, Grossman W. Coronary arteriovenous fistula presenting as congestive heart failure. Cathet Cardiovasc Diagn. 1992;26(1):19-25. [crossref] [PubMed]
Mangukia CV. Coronary artery fistula. Ann Thorac Surg. 2012;93(6):2084-92. [crossref] [PubMed]
Sommer RJ, Hijazi ZM, Rhodes JF Jr. Pathophysiology of congenital heart disease in the adult: Part I: Shunt lesions. Circulation. 2008;117(8):1090-99. [crossref] [PubMed]
Said SA, Schiphorst RH, Derksen R, Wagenaar LJ. Coronary-cameral fistulas in adults: Acquired types (second of two parts). World J Cardiol. 2013;5(12):484-94. [crossref] [PubMed]
Wilde P, Watt I. Congenital coronary artery fistulae: Six new cases with a collective review. Clin Radiol. 1980;31(3):301-11. [crossref] [PubMed]
Mansour MK, Nagalli S. Coronary Cameral Fistula. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022.
Lim JJ, Jung JI, Lee BY, Lee HG. Prevalence and types of coronary artery fistulas detected with coronary CT angiography. AJR Am J Roentgenol. 2014;203(3):W237-43. [crossref] [PubMed]
Abrams LD, Evans DW, Howarth FH. Coronary artery–right ventricular fistula treated surgically. Br Heart J. 1967;29(1):132-34. [crossref] [PubMed]
Morgan JR, Forker AD, O’Sullivan MJ, Fosburg RG. Coronary arterial fistulas: Seven cases with unusual features. Am J Cardiol. 1972;30(4):432-36. [crossref] [PubMed]
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. [crossref] [PubMed]
Minhas AM, Ul Haq E, Awan AA, 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. 2017:8071281. Doi: 10.1155/2017/8071281. [crossref] [PubMed]
Yu X, Wang X, Zhang R, Xu F, Ji F. Spontaneous closure of an iatrogenic coronary artery fistula during recanalization of a chronic total occlusion lesion: A case report. Medicine. 2019;98(3):e14068. [crossref] [PubMed]
Mertens A, Dalal P, Ashbrook M, Hanson I. Coil embolization of coronary-cameral fistula complicating revascularization of chronic total occlusion. Case Rep Cardiol 2018:6857318. Doi: 10.1155/2018/6857318. [crossref] [PubMed]

DOI and Others

DOI: 10.7860/JCDR/2022/56857.17164

Date of Submission: Apr 10, 2022
Date of Peer Review: May 25, 2022
Date of Acceptance: Aug 05, 2022
Date of Publishing: Nov 01, 2022

• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

• Plagiarism X-checker: Apr 27, 2022
• Manual Googling: May 25, 2022
• iThenticate Software: Aug 04, 2022 (17%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)