Abstract
BackgroundCongenital coronary-pulmonary fistulas (CPFs) are commonly unilateral; however, bilateral and multilateral fistulas are relatively rare. The steal phenomenon aroused from bilateral or multilateral CPFs, and was uncertain and seldom reported. We possess a new tool to assess the hemodynamic significance of coronary artery fistulas. This study aimed to describe the clinical presentation, diagnostic modalities, and management of the coincidentally detected congenital bilateral CPFs.Case presentationA case of a 52 year-old female with 10 years history of typical palpitations and chest tightness was presented. The selective coronary arteriography showed a right dominant coronary circulation without significant stenosis; however, with anomalous vessels originating from the proximal right and left anterior descending coronary arteries, draining into the pulmonary artery through a plexus of small vessels. We introduced the fractional flow reserve (FFR) to evaluate the hemodynamic significance of CPFs. The patient was successfully treated with coil embolization.ConclusionsWe presented the case of a female with typical palpitations and chest tightness due to the steal phenomenon that aroused from bilateral CPFs. The fistulas were safely and successfully closed by coil embolization. We showed a new tool for the sophisticated evaluation of the hemodynamic significance of CPFs using FFR measurement and temporary occlusion of the fistula with a standard balloon. FFR could be a promising means for the treatment of decision making of the CPFs.
Highlights
Congenital coronary-pulmonary fistulas (CPFs) are commonly unilateral; bilateral and multilateral fistulas are relatively rare
We presented the case of a female with typical palpitations and chest tightness due to the steal phenomenon that aroused from bilateral CPFs
We showed a new tool for the sophisticated evaluation of the hemodynamic significance of CPFs using fractional flow reserve (FFR) measurement and temporary occlusion of the fistula with a standard balloon
Summary
Congenital coronary-pulmonary fistulas (CPFs) are commonly unilateral; bilateral and multilateral fistulas are relatively rare. The selective coronary arteriography showed a right dominant coronary circulation without significant stenosis; with anomalous vessels originating from the proximal right and left anterior descending coronary arteries, draining into the pulmonary artery through a plexus of small vessels. Case presentation A 52 year-old female with hyperlipidemia history was admitted to our hospital with 10 years history of typical palpitations and chest tightness She was diagnosed with coronary artery disease (CAD) and received its therapeutic regimen. The selective coronary arteriography (Fig. 1a) presented a right dominant coronary circulation without significant stenosis; with anomalous vessels originating from the proximal right and left anterior descending coronary arteries, draining into the pulmonary artery through a plexus of small vessels. The patient felt that her symptoms were relieved and reported absence of any discomforts during the 1-year follow-up period
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