Coronary Arteriovenous Fistula Originating From the Left Main Coronary Artery

Area of Science:

• Cardiology
• Medical Imaging
• Clinical Case Study

Background:

• Coronary artery fistulas are abnormal connections between a coronary artery and a cardiac chamber or vessel.
• While often congenital, acquired fistulas can occur post-procedure or due to trauma.
• Left main coronary artery origin is an uncommon presentation.

Observation:

• A 62-year-old male presented with atrial fibrillation.
• Transthoracic echocardiogram raised suspicion for a coronary artery fistula.
• Cardiac computed tomographic angiography and cardiac catheterization confirmed the diagnosis.

Findings:

• The coronary artery fistula originated from the left main coronary artery, a rare anatomical variation.
• The fistula terminated in the coronary sinus.
• The patient was asymptomatic from the fistula itself.

Implications:

• Multi-modality imaging is crucial for accurate anatomical delineation and treatment planning.
• Management strategies range from conservative observation for small, asymptomatic fistulas to interventional closure for large or symptomatic ones.
• Conservative management with serial echocardiographic monitoring was chosen for this asymptomatic patient.