Coronary artery-pulmonary artery fistula in a heart-transplanted patient
Tom Vermeulen1, Steven Haine, Bernard P Paelinck
1Department of Cardiology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium. tom.vermeulen@uza.be
Insights
A cardiac transplant patient unexpectedly developed a coronary-pulmonary artery fistula. This rare condition involved multiple coronary arteries feeding into the pulmonary trunk, but a conservative approach was chosen due to the patient
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Transplant Cardiology
Background:
- Routine cardiac catheterization was performed one year post-cardiac transplantation for end-stage ischemic cardiomyopathy.
- The patient had no significant cardiac symptoms or complaints at the time of the procedure.
Observation:
- Selective coronary angiography revealed an unusual coronary-pulmonary artery fistula.
- The fistula originated from three feeding vessels: the right coronary artery, left anterior descending artery, and circumflex artery, with a contribution from the left main coronary artery.
Findings:
- The fistula drained directly into the pulmonary trunk.
- Cardiac dimensions and hemodynamic findings were within normal limits.
- Despite the anomaly, the patient remained asymptomatic.
Implications:
- This case highlights a rare complication or incidental finding following cardiac transplantation.
- The asymptomatic nature and normal hemodynamics supported a conservative management strategy.
- Further research may explore the incidence and long-term implications of such fistulas in transplant recipients.
Abstract:
A 64-year-old-man underwent routine elective right-left heart catheterization, 1 year after cardiac transplantation for terminal ischaemic cardiomyopathy. Surprisingly, selective coronary angiography disclosed coronary-pulmonary artery fistula with three feeding vessels originating from the proximal right coronary artery, the proximal portion of the left anterior descending artery, the circumflexus artery, and the left main coronary artery, draining into the pulmonary trunk. For this particular patient, without any significant cardiac complaints or symptoms, with normal cardiac dimensions and haemodynamic findings, a conservative approach was decided on.
