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A case of left main coronary artery to pulmonary fistula associated with vasospastic angina

Kentaro Shirakura1, Shougo Takahashi1, Kaname Shimizu1

  • 1Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa 078-8510, Japan.

Journal of Surgical Case Reports
|April 7, 2025
PubMed

Insights

Coronary artery fistulas (CAFs) can cause myocardial ischemia. This case highlights that CAFs may also trigger vasospasm, a complication potentially missed during preoperative diagnostics for coronary artery-pulmonary artery fistulas.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Vascular Medicine

Background:

  • Coronary artery fistulas (CAFs) are uncommon congenital heart defects.
  • Coronary artery-pulmonary artery fistulas can induce myocardial ischemia via coronary steal, stenosis, or vasospasm.

Observation:

  • A 73-year-old male presented with a coronary artery-pulmonary artery fistula and significant right coronary artery stenosis.
  • Initial diagnostic tests, including myocardial scintigraphy and resting ECG, did not reveal ischemia.
  • Exercise ECG suggested coronary steal syndrome due to diffuse ST depression.

Findings:

  • Surgical closure of the fistula was complicated by intraoperative coronary spasms and ventricular fibrillation.
  • The patient required mechanical circulatory support, including intra-aortic balloon pump and ECMO.
  • This case demonstrates that coronary artery fistulas can be associated with vasospasm.

Implications:

  • Vasospasm associated with CAFs may be underestimated in preoperative evaluations.
  • Thorough preoperative assessment for vasospastic angina is crucial in patients with coronary artery fistulas.
  • Understanding this association can improve patient management and surgical outcomes for rare coronary anomalies.

Keywords:
coronary artery fistulavasospastic angina

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