Coronary Artery Aneurysm and Fistula With Left Ventricular Drainage

Abstract

An 86-year-old woman with hypertension, diabetes, and hyperlipidemia was admitted to our institution with chest pain and dyspnea. Coronary computed tomography (CT) angiography showed tortuous and aneurysmal coronary arteries. The left main coronary artery has a diameter of 10.1 mm (Fig. 1A). The left anterior descending artery and first diagonal branch course through the myocardium (Fig. 1, B and C) and appear to communicate with the left ventricular cavity through multiple small arterial tributaries (Fig. 1, D and E, arrows). There is also an 11.5 mm 10.5 mm aneurysm of the posterior lateral branch of the right coronary artery (Fig. 1F, arrow). Coronary arteriovenous fistula (CAVF) is an anomalous communication between coronary arteries and the cardiac chambers or vessels. Connections involving the coronary arteries and a cardiac chamber may represent persistence of embryonic intratrabecular spaces and sinusoids. The incidence of CAVF is estimated to be 0.4% of congenital heart disease or roughly 1 in 50,000 patients with congenital heart disease. Fistulous drainage occurs into the right ventricle in 40%, into the right atrium in 26%, into the pulmonary artery in 17%, into the coronary sinus in 7%, into the left ventricle in 3%, and into the superior vena cava in 1% of cases. Symptoms and complications develop with increasing age and depend on the size and location of the