A Complicated Case Report of Coronary Artery Fistula

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Surgery

Background:

• Coronary artery fistulas (CAFs) are rare abnormal connections between coronary arteries and heart chambers or other vessels.
• While often asymptomatic in youth, CAFs can lead to significant complications like myocardial ischemia, heart failure, and arrhythmias with age.
• Diagnosis can be challenging due to nonspecific symptoms, necessitating advanced imaging for angioarchitecture assessment.

Observation:

• A 50-year-old male presented with exertional dyspnea and chest pain, indicative of severe symptoms related to a CAF.
• Digital subtraction angiography revealed complex fistulous connections from the left anterior descending and right coronary arteries into the left ventricle via aneurysms.
• The patient exhibited signs of congestive heart failure and an abnormal murmur was noted on auscultation.

Findings:

• Percutaneous transcatheter embolization using a vascular plug successfully closed the complex CAF.
• The procedure, though challenging due to the fistula's complexity, resulted in immediate symptom resolution.
• Post-procedure follow-up, including CT angiography at one year, confirmed successful fistula closure without adverse effects on coronary arteries.

Implications:

• Percutaneous closure is a safe, effective, and minimally invasive treatment for symptomatic CAFs.
• Successful embolization can significantly improve patient quality of life by resolving debilitating symptoms.
• This case highlights the importance of considering CAF in patients with unexplained cardiac symptoms and the efficacy of endovascular techniques for management.