Coronary artery fistula with left or right ventricular communication and sinus-node dysfunction

Area of Science:

• Cardiology
• Congenital Heart Disease
• Electrophysiology

Background:

• Coronary artery fistulae (CAF) are abnormal connections between coronary arteries and heart chambers.
• CAF communicating with the left ventricle (LV) are exceptionally rare.
• Co-occurrence of CAF with sinus-node dysfunction (SND) is even more unusual.

Purpose of the Study:

• To report two rare cases of congenital coronary artery fistulae with left ventricular communication and sinus-node dysfunction.
• To explore the potential link between coronary artery fistulae and sinus-node dysfunction.

Main Methods:

• Case report of two patients presenting with congenital coronary artery fistulae and sinus-node dysfunction.
• Detailed clinical evaluation, including anatomical assessment of fistulae and electrophysiological studies.

Main Results:

• Two patients presented with congenital coronary artery fistulae originating from both left and right coronary arteries, communicating with the left ventricle.
• One patient also had a right coronary artery fistula communicating with the right ventricle.
• Sinus-node dysfunction was observed in both patients, likely secondary to chronic ischemia caused by a steal syndrome from the fistulae.

Conclusions:

• Congenital coronary artery fistulae to the left ventricle, particularly when associated with sinus-node dysfunction, represent a rare clinical entity.
• A steal syndrome resulting from these fistulae may be the underlying mechanism for the observed sinus-node dysfunction.