Coronary artery fistula draining into pulmonary artery and optimal management: a review

Abstract

Coronary artery fistula is a rare congenital malformation of high variability. The disease is illustrated with a description of a case example. The management of patients with coronary artery fistulas remains controversial. Both spontaneous regression and life threatening complications have been described. The fistula can be ligated or embolised; however, there are no long term outcome data regarding management. Intraoperative risk of myocardial infarction is less than 5% and death rate varies between 0% and 6%. Due to a small number of cases being described in the literature and a lack of evidence on optimal management, further research is needed in order to determine the best treatment options.

Keywords: cardiac surgery; congenital heart disease; coronary artery disease.

Figure 1

Picture of a coronary angiogram showing an abnormal coronary fistula arising from the left anterior descending artery and draining into the pulmonary artery.

Figure 2

Intraoperative view of the coronary artery fistula arising from the left anterior descending artery and draining into the pulmonary artery. The origin is coloured with purple marker.

Figure 3

The fistula has been closed of using a slip knot. It was applied in the most proximal aspect of the fistula (closest to left anterior descending artery).