Repairing Bilateral Coronary-Pulmonary Artery Fistulas During Coronary Artery Bypass Grafting
Alexander L Chen1, Alessandro Vivacqua1, Jeffrey M Altshuler1
1Department of Cardiovascular Surgery, Corewell East William Beaumont University Hospital, Royal Oak, Michigan.
Insights
Coronary-pulmonary artery fistulas (CPAFs) are rare, complicating bypass surgery. This case demonstrates successful surgical repair of bilateral CPAFs alongside coronary artery disease treatment.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Thoracic Surgery
Background:
- Coronary-pulmonary artery fistulas (CPAFs) are uncommon congenital or acquired abnormalities.
- CPAFs can lead to significant left-to-right shunting, potentially complicating cardiac procedures.
- Limited guidelines exist for managing CPAFs concurrently with coronary artery disease (CAD).
Observation:
- A 60-year-old male presented with symptomatic coronary artery disease and bilateral CPAFs.
- The patient underwent a complex surgical procedure involving multiple interventions.
- The surgical approach aimed for complete fistula closure and myocardial protection.
Findings:
- Successful surgical management of bilateral CPAFs in conjunction with coronary artery bypass grafting.
- The procedure included epicardial ligation and transpulmonary closure with patch reconstruction.
- The patient experienced a favorable outcome without evidence of coronary steal.
Implications:
- This case provides valuable insight into the successful concomitant treatment of CPAFs and CAD.
- Highlights the importance of meticulous surgical technique for fistula closure and myocardial protection.
- Suggests that a combined surgical approach can be effective in managing complex CPAF and CAD cases.
Abstract:
Coronary-pulmonary artery fistulas (CPAFs) are rare entities that can cause significant left-to-right shunting and complicate routine coronary artery bypass grafting. There are no best practice guidelines and a scarcity of reports regarding concomitant treatment of CPAF with coronary artery disease. We present a case of bilateral CPAFs in a 60-year-old man with symptomatic coronary artery disease treated successfully with coronary artery bypass, epicardial ligation, and transpulmonary closure of CPAF with patch reconstruction. This case highlights the importance of optimal myocardial protection and complete closure of the fistula to prevent risk of coronary steal.
