[Cardiac computed tomography in preoperative management of a congenital coronary anomaly]

Area of Science:

• Cardiology
• Vascular Surgery
• Diagnostic Imaging

Background:

• Coronary artery fistulas are rare abnormalities where blood shunts into cardiac chambers or great vessels.
• Low-pressure structures are common drainage sites, and presentation depends on shunt severity.

Observation:

• An 81-year-old man presented with stable exercise angina pectoris and a positive stress test.
• Coronaro-angiography revealed a fistula between the left anterior descending artery and the pulmonary artery trunk.
• A significant lesion was noted in the mid-LAD distal to the fistula origin.

Findings:

• Cardiac computed tomography confirmed the coronary artery fistula and associated LAD lesion.
• The fistula created an abnormal connection, impacting coronary blood flow and contributing to angina.

Implications:

• This case highlights the importance of advanced imaging like cardiac CT for diagnosing complex coronary artery anomalies.
• Surgical or percutaneous intervention may be necessary to close fistulas and treat associated coronary lesions.
• Understanding fistula anatomy is crucial for successful treatment planning and patient outcomes.