A rare case of coronary fistula evaluated by first-pass radionuclide angiography

Area of Science:

• Cardiology
• Radiology
• Medical Imaging

Background:

• Coronary artery fistula (CAF) is a rare congenital or acquired cardiovascular anomaly.
• CAFs involve abnormal connections between coronary arteries and cardiac chambers or great vessels.

Observation:

• A 77-year-old woman presented with dyspnea on exertion, a common symptom in cardiac conditions.
• Diagnostic workup included coronary angiography and cardiac multidetector computed tomography (MDCT).

Findings:

• The patient was diagnosed with a coronary artery fistula draining into the left bronchial arteries.
• First-pass radionuclide angiography (FPRNA) demonstrated early pulmonary recirculation, indicative of a left-to-right shunt.
• The pulmonary to systemic blood flow ratio (Qp:Qs) was calculated at 1.24.

Implications:

• FPRNA provides crucial physiological information for managing complex cardiovascular cases.
• Supportive care with vasodilators and antiplatelet therapy was initiated.
• Accurate diagnosis and physiological assessment are key for treatment planning in rare coronary anomalies.