title: Progressive coronary artery-pulmonary artery fistula after size-mismatch cardiac transplantation.
abstract: Patients who have undergone cardiac transplantation are occasionally complicated by the development of a coronary artery fistula. It has been reported that a majority of coronary artery fistulas in a post-heart transplant setting communicate with the right ventricle. Moreover, most had a favorable prognosis and were rarely associated with hemodynamic disorder. In contrast, the present report describes a case with a progressive coronary artery fistula that drained into the pulmonary artery in a Japanese male who underwent size-mismatch orthotopic cardiac transplantation from a white male donor. The fistula gradually enlarged and a left-to-right shunt deteriorated over a 5-year period after transplantation. In this case, because the coronary fistula drained into the pulmonary artery, endomyocardial biopsy was not considered as a possible cause of the fistula. It is conceivable that size-mismatch heart transplantation may be associated with the development of fistula.
authors.affiliation: Department of Cardiovascular Medicine, University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Takumi J
authors.initials: TJ
authors.lastname: Matsubara
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Iwata
authors.forename: Taro
authors.initials: T
authors.lastname: Shiga
authors.forename: Masaru
authors.initials: M
authors.lastname: Hatano
authors.forename: Atsushi
authors.initials: A
authors.lastname: Yao
authors.forename: Minoru
authors.initials: M
authors.lastname: Ono
authors.forename: Koichiro
authors.initials: K
authors.lastname: Kinugawa
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Hirata
authors.forename: Ryozo
authors.initials: R
authors.lastname: Nagai
mesh_terms: D000293:Adolescent; D002404:Catheterization; D003331:Coronary Vessels / Q000473:pathology*; D005402:Fistula / Q000150:complications / Q000473:pathology*; D006085:Graft Survival; D016027:Heart Transplantation / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D011651:Pulmonary Artery / Q000473:pathology*; D016896:Treatment Outcome