Large bilateral coronary artery fistulae

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Obstetrics

Background:

• Coronary artery fistulae are uncommon congenital or acquired abnormal connections between a coronary artery and a cardiac chamber or great vessel.
• Large or multiple fistulae can lead to significant shunting, potentially causing myocardial ischemia, heart failure, or pulmonary hypertension.

Observation:

• A case of large bilateral coronary artery fistulae is presented in a pregnant woman.
• The patient experienced transient palpitations during pregnancy but remained otherwise asymptomatic.
• Her hemodynamic status remained robust throughout multiple pregnancies, suggesting good compensatory mechanisms.

Findings:

• The presence of large bilateral coronary artery fistulae was confirmed.
• Conservative management was elected due to the patient's asymptomatic presentation and stable hemodynamics.
• The potential for developing pulmonary hypertension due to the significant cardiovascular shunt was noted.

Implications:

• Conservative management may be appropriate for asymptomatic patients with large coronary artery fistulae, especially during pregnancy.
• Closure of coronary artery fistulae should be considered in select cases to prevent long-term complications like pulmonary hypertension.
• This case highlights the importance of individualized assessment in managing coronary artery anomalies during pregnancy.