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[A case report of a coronary fistula from left coronary artery to left ventricle]
1Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical College, Japan.
Insights
This study reports the first documented case of a coronary fistula discovered after Transmyocardial Laser Revascularization (TMLR). The fistula originated from the left coronary artery and drained into the left ventricle, found during treatment for coronary artery disease.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Imaging
Background:
- A 44-year-old male patient presented with a history of effort-induced chest pain since 1994, diagnosed as unstable angina in 1996.
- Coronary angiography revealed three-vessel disease, necessitating surgical intervention.
Observation:
- Coronary Artery Bypass Grafting (CABG) was performed for the right and left anterior descending arteries.
- Transmyocardial Laser Revascularization (TMLR) was utilized for the posteroinferior region due to an ungraftable left circumflex artery.
Findings:
- Post-operative assessment confirmed patent grafts and improved left ventricular (LV) function.
- A rare coronary fistula, originating from the left coronary artery and draining into the left ventricle, was identified.
Implications:
- This represents the first reported instance of a coronary fistula detected subsequent to TMLR.
- The findings may prompt further investigation into the potential iatrogenic causes or associations of coronary fistulas following TMLR procedures.
Abstract:
The patient is a 44-year-old man. He has had chest pain on effort since 1994, diagnosed as unstable angina in 1996. He was found to have three vessel disease on coronary angiography and was sent to TWMC for operation. CABG was performed for the right and left anterior descending arteries, and TMLR for the posteroinferior region because the left circumflex artery was fine and ungraftable. Both the grafts were patent and there was improved LV function. Interestingly, we found a coronary fistula running from the left coronary artery to the left ventricle. As far as we can tell from our literature searches, this is the first time that a coronary fistula has been found after TMLR.