Coronary vessels anomalies. Coronary-pulmonary arterial fistula – clinical case and literature review.

Abstract

Coronary artery fistula (CAF) is an anomalous connection between a coronary artery and a cardiac chamber or major vessel thus bypassing the myocardial microcirculation and leading to ischemia. These anomalies are most often discovered incidently during a coronary angiography or heart computer tomography (CT) [1]. The frequency of the CAF in the population is around 0.002%, and representing 0.2%-0.3% of all congenital heart malformations [1,2,3]. They are found in 0.3% to 0.8% of the patients undergoing diagnostic heart catherization [4].

The clinical manifestation of this condition depends on the type of the fistula, the severity of the shunt, the underlying coronary anatomy, and also the accompanying heart diseases. CAF represents abnormal communication between the coronary and pulmonary artery. The treatment of this asymptomatic patients with such fistulas is debatable and needs further investigation and researches. Though, the main factors, that need to be taken into consideration when choosing the therapeutic strategy are the related size of the fistula, the age of the patient, existence of comorbidities, the symptoms, and the pros and cons of interventional or operative procedure approach [3,5].

We present a clinical case of an 84-year old patient with diagnosed vessel communication between Left anterior descending artery (LAD, anterior interventricular branch of left coronary artery) and Pulmonary artery (PA), presenting with the clinic of acute coronary syndrome.