Left Coronary Artery-Right Ventricle Fistula Case Report: Optimal Treatment Decision

Area of Science:

• Cardiology
• Congenital Heart Disease
• Medical Imaging

Background:

• Coronary artery fistulas (CAFs) are uncommon congenital abnormalities where coronary arteries abnormally connect to cardiac chambers or great vessels.
• Clinical presentations range from heart failure and ischemia to arrhythmias and infective endocarditis.

Observation:

• A 39-year-old male presented with edema and suspected right ventricular (RV) abnormality, later diagnosed as a left anterior descending (LAD) coronary artery-RV fistula with aneurysmal sacs.
• Multimodal imaging including transthoracic echocardiography (TTE), CT, coronary angiography, and cardiac MRI confirmed the fistula and aneurysms, showing preserved biventricular function.
• Despite initial recommendation for surgical intervention, the patient declined and remained asymptomatic with stable findings on follow-up imaging over several years.

Findings:

• The case illustrates a rare congenital coronary artery fistula with significant aneurysmal dilation.
• Multimodal imaging is crucial for accurate diagnosis and comprehensive assessment of CAFs.
• The patient demonstrated stable disease progression and remained asymptomatic despite the presence of a large fistula and aneurysms.

Implications:

• Individualized management strategies, including surgical, percutaneous, or conservative approaches, are essential due to the variable presentation and outcomes of CAFs.
• Continuous monitoring and follow-up are vital for managing potential complications and guiding treatment decisions, even in asymptomatic individuals.
• This case underscores the importance of a multidisciplinary approach in managing complex congenital heart anomalies like coronary artery fistulas.