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Coexistent mitral stenosis and coronary artery fistula presenting as myocardial ischemia: case report

C L Lin1, Y F Chen, C C Chiu

  • 1Division of Cardiovascular Surgery, Kaohsiung Medical College, Taiwan, Republic of China.

The Kaohsiung Journal of Medical Sciences
|February 1, 1997
PubMed

Insights

Mitral stenosis can mask congenital coronary artery fistula symptoms. Surgical correction of both conditions resolved severe myocardial ischemia in a rare case, highlighting the importance of considering fistula in unexplained ischemia.

Area of Science:

  • Cardiology
  • Congenital Heart Disease
  • Vascular Surgery

Background:

  • Mitral stenosis and coronary artery fistula are rare conditions.
  • Their co-occurrence is exceptionally rare, complicating diagnosis.
  • Congenital coronary artery fistulas can lead to myocardial ischemia.

Observation:

  • A 50-year-old female presented with mitral stenosis and congestive heart failure.
  • Severe myocardial ischemia was noted on electrocardiogram, with no clear clinical cause.
  • Coronary angiography revealed a congenital coronary artery fistula from the left anterior descending artery to the pulmonary artery.

Findings:

  • The patient initially received medical treatment for heart failure.
  • Surgical correction of both mitral stenosis and the coronary artery fistula was performed.
  • Post-surgery, myocardial ischemia significantly improved.

Implications:

  • This case highlights that mitral stenosis can mask coronary artery fistula symptoms.
  • Unexplained myocardial ischemia in the presence of valvular heart disease warrants consideration of coronary artery fistula.
  • Early diagnosis and surgical intervention are crucial for favorable outcomes in such rare cases.

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