Coronary Fistula Between Left Anterior Descending Artery (LAD) and Pulmonary Artery (PA) Leading to Sudden Cardiac Death: Case Report with Literature Review

Abstract

<jats:sec> <jats:title /> <jats:p>Coronary Artery Fistulas (CAF) are inappropriate connections between a coronary artery and a major vessel or a cardiac chamber. These fistulas may or may not present with symptoms, but they need to be detected as early as possible in order to decide the most appropriate treatment methodology (i.e. surgery vs. conservative management). We report the case of a 67-year-old female with no modifiable cardiovascular risk factors who had an unwitnessed sudden death at home during her ongoing evaluation of a fistula detected incidentally between the Left Anterior Descending Artery (LAD) and the Pulmonary Artery (PA). This case highlights that early diagnosis and treatment of symptomatic CAF are crucial to minimize the risk of sudden cardiac death. Although the symptomatic fistula of LAD to PA has been reported in the literature multiple times, it has been rarely reported that this fistula can result in sudden cardiac death.</jats:p> </jats:sec>

Reversible Pulmonary Hypertension due to Combined Fistula between the Left Anterior Descending Artery (LAD) and Pulmonary Artery and Severe Stenosis of the LAD

“…More specifically, the basic factors that affect the hemodynamic status of the patient are the steal phenomenon, which is usually combined with atheromatic coronary disease [9], and the shunt that affects the function of the involved structures, which may be the main cause for congestive heart failure in 20% of the patients [5]. There are cases that sudden death is reported due to LAD-PA fistula and ischemia is reported even in a patient without the presence of stenotic coronary artery as a consequence of extreme steal phenomenon [10,11]. In this case report, PASP and increased right ventricle volume were found at the patient's admission while 2 years before these findings were absent.…”

Images in cardiovascular medicine voluminous left main stem to pulmonary artery fistula: A conservative approach

“…A coronary‐pulmonary artery fistula (CPAF) is a rare cardiac abnormality, found in 0.3% to 0.8% of the patients 1,2 . The majority of coronary artery fistulae are related to the right coronary artery (55%), while 35% arise from the left anterior descending artery.…”

“…The majority of coronary artery fistulae are related to the right coronary artery (55%), while 35% arise from the left anterior descending artery. Low‐pressure structures are the most common sites of drainage of the coronary artery fistula which communicates with the right side of the heart in 90% of the case 1‐3 . Most adult patients are usually asymptomatic and a fistula is incidentally identified by different cardiac imaging modalities.…”

“…Most adult patients are usually asymptomatic and a fistula is incidentally identified by different cardiac imaging modalities. Nevertheless, it has been reported that CPAF can result in sudden cardiac death 1 . Management and treatment options can vary and depend on a single patient.…”

“…The optimal treatment of CPAF is still a matter of debate considering the reduced number of clinical cases and the variability of anatomical conditions and presentation. Surgical intervention is usually indicated if there is a shunt of more than 30%, cardiac ischemia, advanced pulmonary hypertension or congestive heart failure, a history of infectious endocarditis, and/or aneurysmal formation 1,2 …”