Abstract

Coronary artery fistulas are rare anomalies found during coronary angiography and non-invasive cardiac imaging. Recent advances in understanding of the pathophysiology allow more effective surgical and percutaneous treatments. It is important to recognize and treat hemodynamically significant fistulas when appropriate before ischemia and or heart failure occurs. We present a case of coronary artery fistula that was treated conservatively after a heart team discussion.

Highlights

  • Coronary artery fistulas (CAF) are rare cardiac anomalies

  • Coronary artery fistulas are rare anomalies found during coronary angiography and non-invasive cardiac imaging

  • We present a case of coronary artery fistula that was treated conservatively after a heart team discussion

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Summary

Introduction

Coronary artery fistulas (CAF) are rare cardiac anomalies. Since the increase use of computer tomography coronary angiography, prevalence of CAF increased from 0.3% up to 0.9% of congenital heart disease [1,2]. We report a case of a congenital coronary artery fistula diagnosed during evaluation of mild dyspnea. Subsequent cardiac catheterization showed very large normal coronary arteries with arteriovenous fistula (Video 1). Coronary computer tomography angiography (CT) showed markedly dilated 10 mm left main coronary artery, 8 mm left anterior descending artery, and a 12 mm left circumflex coronary arteries. The patient was evaluated by cardiothoracic surgery and after a heart team discussion, a decision was made to continue medical management and to closely monitor for aortic root growth. The patient was evaluated by cardiothoracic surgery and after a heart team discussion, a decision was made to continue medical management and to closely monitor for aortic root growth. 1 year later, the patient remained asymptomatic with no further enlargement of the aortic root aneurysm

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