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[Multiple pulmonary coronary fistulae. Apropos of a case]
M M Sahnoun1, Y Guérin, J Baligadoo
1Service de Cardiologie, Hôpital Boucicaut, Paris.
Insights
A rare congenital anomaly, coronary-pulmonary fistula, often presents in adulthood. This case highlights a double fistula alongside atheromatous lesions, requiring combined surgical intervention.
Area of Science:
- Cardiology
- Congenital Heart Disease
- Vascular Surgery
Background:
- Coronary-pulmonary fistula is a rare congenital anomaly typically diagnosed in adulthood.
- Diagnosis often occurs incidentally during coronary angiography for myocardial ischemia.
- Multiple coronary fistulae represent an even rarer presentation.
Observation:
- A 61-year-old male presented with angina due to a double coronary-pulmonary fistula.
- The fistulae were accompanied by significant coronary artery stenoses and occlusions.
- The coexistence of congenital fistulae and atheromatous disease prompted investigation into their relationship.
Findings:
- Coronary angiography confirmed the presence of a double coronary-pulmonary fistula.
- Associated atheromatous lesions (stenoses and occlusions) were identified.
- The pathological link between congenital fistulae and acquired atheromatous disease was explored.
Implications:
- Accurate diagnosis via coronary angiography is crucial for treatment planning.
- Treatment necessitates a combined approach, addressing both fistula exclusion and coronary revascularization.
- Understanding the interplay between congenital and acquired coronary pathologies is vital for patient management.
Abstract:
Coronary-pulmonary fistula is a rare congenital anomaly. It is usually detected fortuitously in adulthood during a coronary angiography carried out to assess signs of myocardial ischemia. Multiple coronary fistulae are still more rare. Coronary angiography evaluates the lesions and indicates the most appropriate treatment. The congenital lesions are frequently combined with atheromatous lesions. The case described is that of a double fistula in a 61-year old man which was revealed by angina; the stenoses and occlusions which accompanied the fistulae lead to a discussion of their atheromatous nature and the nature of the pathological link between them: is this fortuitous or are they a progressive complication? Treatment involves both exclusion of the fistulae and coronary revascularization.