Bilateral coronary artery fistulas with multiple sites of drainage

Area of Science:

• Cardiology
• Congenital Heart Disease
• Vascular Malformations

Background:

• Coronary artery fistulas (CAFs) are abnormal connections between a coronary artery and a heart chamber or major vessel.
• While CAFs are rare, bilateral involvement with multiple drainage sites is exceptionally uncommon.
• Diagnosis typically involves coronary arteriography.

Observation:

• A 49-year-old woman presented with a cardiac murmur.
• Coronary arteriography revealed bilateral coronary artery fistulas.
• Specific findings included one fistula from the left anterior descending artery to the pulmonary artery and three from the right coronary artery's conal branch draining into the pulmonary artery, right atrium, and great cardiac vein.

Findings:

• This case represents the first documented instance of bilateral coronary artery fistulas with multiple drainage points.
• The complex anatomy involved drainage into distinct cardiovascular structures.
• The patient's presentation with a cardiac murmur prompted the diagnostic investigation.

Implications:

• This case expands the understanding of coronary artery fistula anatomy and presentation.
• It highlights the importance of thorough diagnostic evaluation for complex congenital heart anomalies.
• Further research may explore optimal management strategies for such rare and complex cases.