Coronary artery fistula into a persistent left superior vena cava: report of a case

Area of Science:

• Cardiology
• Congenital heart anomalies
• Vascular malformations

Background:

• Coronary artery fistulas (CAFs) are uncommon abnormal connections between a coronary artery and a cardiac chamber or great vessel.
• Persistent left superior vena cava (PLSVC) is a rare congenital anomaly where the left superior vena cava does not regress during embryonic development.
• The simultaneous occurrence of CAF, PLSVC, and absence of the right superior vena cava (RSVC) is exceptionally rare.

Observation:

• A patient presented with a rare combination of cardiovascular anomalies.
• The identified anomalies included a coronary artery fistula (CAF) originating from the left circumflex artery.
• The fistula drained into a persistent left superior vena cava (PLSVC), with a complete absence of the right superior vena cava (RSVC).

Findings:

• Detailed imaging confirmed a direct fistula between the left circumflex coronary artery and the PLSVC.
• The anatomical variations presented a unique diagnostic and potential therapeutic challenge.
• Absence of the RSVC was a significant associated finding, impacting venous return pathways.

Implications:

• This case highlights the importance of recognizing rare congenital cardiovascular anomalies.
• Understanding these variations is crucial for accurate diagnosis and management of patients with complex congenital heart disease.
• Further research into the embryological basis of these combined anomalies may provide insights into cardiovascular development.