A rare case of coronary artery fistula presented with acute myocardial infarction

Area of Science:

• Cardiology
• Radiology
• Vascular Surgery

Background:

• Coronary artery fistulas (CAFs) are abnormal connections between coronary arteries and heart chambers or major vessels.
• Most CAFs are asymptomatic incidental findings during coronary angiography (ICA) or computed tomography angiography (CTA).

Observation:

• A rare case of a 43-year-old female presenting with acute infero-posterior myocardial infarction (AMI).
• Diagnostic imaging (ICA and CTA) revealed a thrombosed CAF between the left main coronary artery and the right atrium.
• The fistula was associated with a completely occluded left circumflex artery due to thrombus extension.

Findings:

• The patient's CAF was complicated by acute myocardial infarction (AMI), an unusual presentation for this anomaly.
• Computed tomography angiography (CTA) played a crucial role in diagnosing and delineating the complex anatomy of the thrombosed CAF and its consequences.
• Conservative management was initiated due to high intervention risks, with plans for future closure.

Implications:

• This case underscores the potential for coronary artery fistulas to cause significant cardiac events like AMI.
• It highlights the diagnostic utility of CTA in identifying and characterizing rare CAF anatomies and complications.
• The findings suggest a need for careful consideration of conservative versus interventional management strategies based on individual patient risk profiles.