Management of a Rare Case of Multiple Coronary Artery Fistulas Associated with Ascending Aortic and Root Aneurysm:...

Area of Science:

• Cardiology
• Cardiac Surgery
• Congenital Heart Disease

Background:

• Coronary artery fistulas (CAFs) draining into the left ventricle are uncommon congenital cardiac anomalies.
• While often asymptomatic, CAFs can precipitate serious complications including heart failure and myocardial ischemia.
• Associated anomalies such as ventricular septal defects and tetralogy of Fallot may be present.

Observation:

• A 61-year-old male presented with left anterior descending and right coronary artery fistulas draining into the left ventricle.
• The patient also had an ascending aorta and root aneurysm.
• Preoperative assessment, including echocardiography stress testing, revealed no significant myocardial ischemia.

Findings:

• Surgical intervention involved ascending aorta replacement and aortic root reconstruction with aortic valve preservation.
• The coronary artery fistulas were intentionally left untreated during this procedure.
• A modified cardioplegia strategy was employed to manage altered coronary hemodynamics and ensure myocardial protection.

Implications:

• This case demonstrates a successful surgical approach for aortic pathology in the presence of untreated coronary artery fistulas.
• The adapted cardioplegia strategy offers a method for myocardial protection in complex cardiac cases with anomalous coronary drainage.
• Further research may explore long-term outcomes of conservative management of CAFs in conjunction with aortic surgery.