Incidental Detection of Left Anterior Descending Artery-Main Pulmonary Artery Fistula

Area of Science:

• Cardiology
• Vascular Surgery
• Radiology

Background:

• Coronary artery fistulas are uncommon congenital or acquired vascular malformations.
• Their prevalence is estimated between 0.1% and 0.2% of the general population.
• Advancements in computed tomography (CT) coronary angiography have increased incidental detection rates.

Purpose of the Study:

• To report a rare case of an incidental coronary artery fistula.
• To highlight the diagnostic utility of CT coronary angiography in identifying coronary anomalies.
• To discuss the management of incidentally discovered, hemodynamically insignificant fistulas.

Main Methods:

• Case report of a 52-year-old male.
• Evaluation for suspected coronary artery disease using CT coronary angiography.
• Identification of a fistulous communication and anomalous coronary artery origins.

Main Results:

• Incidental finding of a small fistulous communication between the left anterior descending (LAD) artery and the main pulmonary artery.
• Co-existing absence of the left main coronary artery with separate origins for LAD and left circumflex artery.
• Patient remained asymptomatic with no significant hemodynamic compromise.

Conclusions:

• CT coronary angiography is crucial for detecting incidental coronary artery anomalies.
• Conservative management is appropriate for asymptomatic patients with small, hemodynamically stable fistulas.
• Accurate identification of coronary anomalies guides clinical decision-making and patient care.