Congenital coronary arteriovenous fistulae in a transplanted heart

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Congenital Heart Disease

Background:

• Coronary artery fistulae are rare abnormal connections between coronary arteries and heart chambers or great vessels.
• Congenital coronary artery fistulae are typically diagnosed in infancy but can present later in life.
• Acquired coronary artery fistulae can occur after cardiac surgery or procedures.

Observation:

• A heart transplant recipient presented with angiographic evidence of multiple congenital fistulae originating from both coronary arteries.
• These fistulae were observed to drain directly into the main pulmonary artery.
• Transthoracic echocardiogram and right heart catheterization were performed to evaluate the shunt's functional significance.

Findings:

• The case documented a unique presentation of coronary artery fistulae in a post-heart transplant patient.
• Angiography confirmed multiple fistulae arising from both coronary arteries with pulmonary artery drainage.
• Functional assessment via echocardiography and right heart catheterization provided hemodynamic data on the shunt.

Implications:

• This case highlights the importance of considering rare congenital anomalies even in post-transplant settings.
• Understanding the pathophysiology and hemodynamics is crucial for managing such shunts.
• Further review of prognosis and treatment strategies for this rare condition is warranted.