[Coronary artery fistula with left atrial myxoma: report of a case]

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Cardiac Oncology

Background:

• Left atrial myxoma is a primary cardiac tumor, often presenting with embolic or obstructive symptoms.
• Coronary artery fistulas (CAFs) are abnormal connections between coronary arteries and cardiac chambers or great vessels; those draining into the pulmonary artery are uncommon.
• Surgical management is indicated for symptomatic myxomas and complex CAFs.

Observation:

• A 64-year-old male presented with a left atrial myxoma requiring surgical intervention.
• Preoperative coronary angiography identified an unusual coronary artery fistula originating from the left anterior descending and circumflex arteries, with drainage into the main pulmonary artery.
• The patient underwent a combined procedure for myxoma resection and fistula closure.

Findings:

• The surgical procedure included resection of the left atrial myxoma, patch closure of an atrial septal defect, and direct closure of the coronary artery fistula using pledgeted mattress sutures.
• The fistula was successfully closed from within the main pulmonary artery during cardiopulmonary bypass.
• Postoperative echocardiography and coronary angiography confirmed the complete resolution of both the left atrial myxoma and the coronary artery fistula.

Implications:

• This case highlights the successful surgical management of a co-existing left atrial myxoma and a rare coronary artery fistula.
• The findings underscore the importance of thorough preoperative evaluation, including coronary angiography, in patients with cardiac tumors.
• Surgical intervention can effectively treat complex congenital cardiovascular anomalies like pulmonary artery draining coronary fistulas alongside other cardiac pathologies.