Silent coronary artery-left ventricular fistula: a disorder of the thebesian system?

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Medical Imaging

Background:

• Coronary artery fistulas are abnormal connections between a coronary artery and a heart chamber or major vessel.
• Most coronary artery fistulas are congenital or acquired due to procedures, often presenting with symptoms like chest pain or heart murmur.
• Diagnosis typically involves echocardiography, CT angiography, or coronary angiography.

Observation:

• Two patients presented with abnormal electrocardiogram (ECG) findings.
• These patients were diagnosed with a direct communication between a coronary artery and the left ventricular chamber.
• The observed fistula was unusual and lacked the common manifestations of previously reported coronary arterial fistulas.

Findings:

• The primary finding is the presence of a rare direct coronary artery-to-left ventricle fistula.
• The absence of typical fistula symptoms in these cases highlights a unique clinical presentation.
• Electrocardiogram abnormalities served as an initial indicator for further investigation.

Implications:

• This case series expands the understanding of coronary artery fistula variations.
• It suggests that direct coronary artery-to-left ventricle fistulas can be asymptomatic or present atypically.
• Further research is needed to elucidate the natural history and optimal management of such rare fistulas.