Colossal left main to right atrium fistula ligation complicated by left circumflex STEMI

Area of Science:

• Cardiology
• Congenital Heart Disease
• Interventional Cardiology

Background:

• Congenital coronary artery fistulas, specifically left main (LM) coronary artery to right atrium (RA) fistulas, are uncommon cardiac malformations.
• While often asymptomatic, these fistulas can progress to aneurysm formation, necessitating intervention in symptomatic patients.
• Surgical intervention for LM-RA fistulas carries significant risks of life-threatening complications.

Observation:

• A rare case of a markedly aneurysmal LM-RA fistula was identified.
• The patient underwent surgical ligation for the fistula.
• Post-operatively, the patient developed an inferolateral ST-elevation myocardial infarction.

Findings:

• The myocardial infarction was successfully treated using a multi-faceted approach.
• Interventions included mechanical aspiration thrombectomy, stent-retriever use, and balloon angioplasty.
• Intravascular ultrasound-guided percutaneous coronary intervention with a drug-eluting stent achieved a favorable outcome.

Implications:

• This case demonstrates the successful management of a rare and complex congenital coronary artery fistula.
• It highlights the potential for serious complications even after surgical treatment.
• The successful application of advanced percutaneous coronary intervention techniques offers a less invasive alternative for managing post-surgical complications in such rare conditions.