Konjenital sağ ve sol koroner arter kaynaklı koroner-pulmoner arter fistülü

Abstract

Coronary artery fistula (CAF) is a rare congenital anomaly with an incidence of 1 in 50 000 live births. The fistula was observed at the right coronary artery in 53%, the left coronary artery in 42% and both coronary artery in 5% of the cases. Echocardiography examination in a 46 year-old woman with the symptoms of chest pain, palpitation and dyspnea revealed a severe mitral valve insufficiency and a moderate to severe tricuspid valve insufficiency. A CAF originating from the proximal part of the left anterior descending artery (LAD) and another fistula originating from osteal part of the right coronary artery (RCA) were detected by coronary angiography. Both fistulas were draining into the main pulmonary artery. The coronary artery fistula closed under cardiopulmonary by-pass. Mitral insufficiency originated from the posterior leaflet was diagnosed intra-operative exploration, and thereafter it was repaired with mitral annuloplasty including a quadrangular resection and use of a 32 No St Jude mitral ring. Tricuspid valve was repaired with Calangos Ring annuloplasty. Following six day hospital stay, the woman was discharged free of any symptom.