A coronary artery fistula having connection between 2 coronary arteries and the left ventricle: A case report
Chang-Yeon Kim1, Ji Yong Choi, Kee Sik Kim
1Division of Cardiology, Daegu Catholic University Medical Center, Daegu, Korea.
Insights
A rare case of coronary artery fistula, where two coronary arteries drained into the left ventricle, was successfully treated with medication. This led to improved cardiac function and resolution of symptoms like dyspnea.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Cardiac Imaging
Background:
- Coronary artery fistulas (CAF) connecting directly to cardiac chambers are uncommon.
- This report details a rare instance of two coronary arteries emptying into the left ventricular cavity.
Observation:
- A 63-year-old woman with hypertension presented with dyspnea and pulmonary edema.
- Echocardiography showed reduced left ventricular function, while coronary angiography and CT revealed a fistula draining into the left ventricle.
Findings:
- The patient received medical management for heart failure, including an ACE inhibitor, loop diuretic, and spironolactone.
- Following treatment, pulmonary edema resolved, dyspnea ceased, and cardiac function improved on follow-up echocardiography.
Implications:
- Coronary artery fistulas can be incidentally discovered during coronary angiography.
- Careful clinical evaluation is crucial for determining the appropriate management strategy for coronary artery fistulas.
Rationale:
Cases of coronary artery fistula having a connection with the cardiac cavity are rare. Here, we report a case in which 2 coronary arteries empty into the left ventricular cavity together.
Patient Concerns:
A 63-year-old woman who was diagnosed as having hypertension 20 years prior presented with dyspnea.
Diagnoses:
The coronary angiography revealed coronary artery fistula.
Interventions:
Chest X-ray showed pulmonary edema. Transthoracic echocardiography revealed moderately decreased left ventricular (LV) function and increased LV end-diastolic volume and mass index. Coronary angiography and cardiac computed tomography revealed that 2 coronary arteries joined together at the distal end and directly drained into the left ventricular cavity bypassing the myocardial capillary vessels. We started medical treatment for heart failure with an angiotensin-converting-enzyme inhibitor, loop diuretic, and spironolactone.
Outcomes:
The pulmonary edema improved rapidly. The patient did not experience dyspnea after discharge, and follow-up echocardiography showed improved cardiac function.
Main Lesson:
Coronary artery fistula could be found incidentally on coronary angiography performed for varied reasons. Physicians must decide carefully whether the fistula needs to be treated in view of the clinical context.
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