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Functional assessment of a left coronary-pulmonary artery fistula by coronary flow reserve
Viktor Sasi1, Attila Nemes1, Tamás Forster1
1Division of Invasive Cardiology, Department of Cardiology, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary.
Insights
A rare coronary artery fistula from the left anterior descending artery to the pulmonary artery was found in a patient with atypical chest pain. Functional evaluation using fractional flow reserve and coronary flow reserve highlighted the fistula's significance.
Area of Science:
- Cardiology
- Vascular Medicine
- Interventional Cardiology
Background:
- Coronary artery fistulas are uncommon congenital or acquired abnormalities.
- Atypical chest pain can be a presenting symptom, necessitating thorough diagnostic investigation.
Purpose of the Study:
- To report a rare case of a coronary artery fistula involving the left anterior descending artery and the main pulmonary artery.
- To emphasize the role of functional assessment in managing such anomalies.
Main Methods:
- Coronary angiography to identify the fistula's anatomy.
- Fractional flow reserve (FFR) and coronary flow reserve (CFR) measurements to assess hemodynamic significance.
Main Results:
- Coronary angiography revealed a fistula between the proximal left anterior descending artery and the main pulmonary artery.
- FFR and CFR measurements provided crucial functional data regarding the fistula's impact.
Conclusions:
- Coronary artery fistulas require comprehensive evaluation beyond anatomical imaging.
- Functional assessment is vital for understanding the hemodynamic implications of coronary artery fistulas.
Abstract:
We report a 71-year-old man who presented with atypical chest pain. Coronary angiography did not reveal left main or proximal left anterior descending coronary artery stenosis, but a fistulous communication with a stronger tube-like fistula was present originating from the proximal left anterior descending coronary artery and emptying into the main pulmonary artery. Fractional flow reserve and coronary flow reserve measurements were performed to gain more data on the potential functional aspects of this fistula. With the present case, the importance of functional evaluation of these fistulas is demonstrated.
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