Left main coronary artery to pulmonary artery fistula presenting as angina and ventricular tachycardia – A case report and literature review

Abstract

Key Clinical Message Coronary artery fistulae are an uncommon abnormality of the coronary arteries, but when hemodynamically significant can present as angina, dyspnea, and arrhythmia as a rare cause of functional myocardial ischemia via ‘coronary steal phenomenon’.

Fistulous communication between the left main coronary artery and the pulmonary artery as a cause of angina

“…CAFs originating directly from the LM are very rare and account for less than 5–35% of cases [ 8 ]. Regarding drainage, most CAFs drain into the right side of the heart, while less than 15–17% drain into the PA [ 8 , 9 ]. Limited case reports have described coronary-pulmonary arterial fistulas (CPAFs), which are uncommon anomalies affecting the coronary arteries.…”

“…Most abnormalities of the coronary arteries are incidentally detected during coronary angiography [ 4 , 5 ]. CCTA is however considered the gold standard for diagnosis today [ 9 ]. CCTA is a valuable and noninvasive imaging modality for identifying CAFs [ 11 ].…”

“…Transesophageal and transthoracic echocardiography are useful in assessing the hemodynamic parameters of CAFs [ 7 ]. The management of CAFs depends on their size and symptoms [ 9 ]. The main indication for closure is the development of symptoms of heart failure and myocardial ischemia.…”

“…Surgical ligation becomes a viable choice if simultaneous distal bypass grafting is required [ 5 ]. Transcatheter intervention is suitable only in cases where the morphology is simple, and the choice of the closure device is based on the anatomical characteristics of the fistula [ 9 ]. Interventional coiling is also an option [ 13 ].…”