Myocardial ischemia due to a large coronary-pulmonary fistula with plexus-like morphology

Area of Science:

• Cardiology
• Congenital Heart Disease
• Vascular Anomalies

Background:

• Congenital coronary-pulmonary artery fistulas are rare cardiac malformations.
• These anomalies involve abnormal connections between coronary arteries and the pulmonary artery.
• Diagnosis and management can be challenging due to their rarity.

Observation:

• A 69-year-old woman presented with a plexus-like congenital coronary-pulmonary artery fistula.
• The fistula originated from the left main stem and proximal left anterior descending and circumflex coronary arteries.
• It connected directly to the main pulmonary artery.

Findings:

• Myocardial perfusion scintigraphy using Tc-99m SPECT revealed inducible ischemia.
• The fistula's large, plexus-like morphology from the proximal left coronary artery is unprecedented.
• This is one of few reported cases demonstrating severe ischemia in such an anomaly.

Implications:

• This case expands the understanding of coronary-pulmonary artery fistula morphology and presentation.
• It underscores the importance of advanced imaging in diagnosing coronary anomalies.
• Such findings may influence surgical or interventional treatment strategies for similar rare conditions.