Coronary artery-left ventricular fistula

Area of Science:

• Cardiology
• Congenital Heart Disease

Background:

• Coronary artery-left ventricular fistulae are exceptionally rare cardiovascular anomalies.
• Only 19 cases have been previously documented in medical literature.

Observation:

• Four new cases of coronary artery-left ventricular fistulae are presented.
• Patients ranged from 5 to 43 years old, with varied clinical presentations including asymptomatic murmurs and angina pectoris.
• Diagnostic methods included hemodynamic studies, electrocardiography, treadmill stress tests, and selective coronary angiography.

Findings:

• One patient had an aneurysmally enlarged right coronary artery draining into the left ventricle, successfully treated with fistula ligation.
• Another patient with a similar right coronary artery fistula refused surgery and remained asymptomatic.
• A third patient presented with angina and multiple fistulae from all major coronary arteries to the left ventricle, managed medically with propranolol.
• The fourth patient, a child, had left coronary artery branches communicating with the left ventricle via fine vessels and remained well without intervention.

Implications:

• Coronary artery-left ventricular fistulae, though rare, require careful diagnosis and individualized management.
• Treatment strategies may include surgical intervention or medical management depending on fistula characteristics and patient condition.
• Further research into the long-term outcomes and optimal treatment of these rare fistulae is warranted.