Traumatic coronary artery fistula

Abstract

Objective: To present a case of traumatic coronary artery fistula caused by blunt injury. Clinical features: A previously healthy 20‐year‐old motor cyclist was involved in a motor vehicle accident. He suffered acute myocardial infarction secondary to a traumatic coronary artery fistula (CAF). His other injuries included a fractured left clavicle, bilateral small pulmonary contusions and pneumothoraces, pneum‐omediastinum and a small subcapsular haematoma of the liver. Intervention and outcome: He was managed conservatively. Recovery was complicated only by pericarditis and he was well one year after the injury. Conclusion: Traumatic CAF may result from blunt chest trauma and may be diagnosed from history, physical examination, and ECG changes. An echocardiogram should be performed in patients with positive ECG findings or the development of a new continuous murmur. Coronary angiography remains the gold standard but is rarely indicated in the acute situation. Regular follow up is required as traumatic CAF has a high incidence of late complications. With symptomatic CAF, the recommended treatment of surgical repair has a high success rate with few complications.