Two Arteriovenosus Fistulas Arising from Circumflex Artery (Cx) and Right Coronary Artery (RCA) to Pulmonary Artery and Coil Embolization of Cx Fistula

Abstract

Coronary artery anomalies are diagnosed coincidentally during conventional coronary angiography or autopsy, although coronary anomalies are the second common cause of the sudden cardiac death in young persons. They are usually benign and they rarely cause signs and symptoms. Some of them comprise arteriovenosus (AV) fistula arising from coronary arteries to the pulmonary artery. AV fistulae arising from a coronary artery to pulmonary artery are rarely encountered but two AV fistulae (CAF) arising from two separate coronary arteries are even rarer, only a few cases having been reported so far. Herein, we present a 53-year-old male patient who was on the waiting list for renal transplantation. He had exercise-induced dyspnea and angina pectoris. The electrocardiogram showed negative T waves in leads V5 and V6. A stress exercise (treadmill) test was performed, which revealed ST-T wave changes confined to leads V5 and V6. Coronary angiography detected two arteriovenous fistulae arising from circumflex (Cx) and right coronary arteries (RCA) to the pulmonary arteries. Right heart catheterization revealed a Qp/Qs ratio of 1:5 a PCWP of 13 mm-Hg, and a PVR of 0.2 Wood units. Coil embolization was carried out for the fistula from RCA to pulmonary artery in the first session, followed by normalization of right heart catheterization indices, leading to cancelling any intervention against the fistula in circumflex (Cx) artery.