Surgical Treatment of a Coronary Artery Fistula that has Opened into the Pulmonary Artery

Introduction: Coronary artery fistula (CAF) is a rare cardiac malformation of congenital, traumatic or iatrogenic origin, and is an abnormal connection between the coronary arteries and the cardiac chambers or the great vessels. The incidence in the general population is estimated to be approximately 0.002%. CAF may be asymptomatic or complicated by congestive heart failure, myocardial ischemia, infective endocarditis, fistula rupture or thrombosis.

Objective: Coronary artery fistulas are very rare malformations, and they need to be kept in mind as a possible cause of myocardial ischemia in patients who present with fatigue, dyspnea, and chest pain.

Case Presentation: A symptomatic patient with CAF and fistulous aneurysm between the left anterior descending artery and the pulmonary artery, treated successfully with cardiopulmonary bypass on arrested heart is presented.

Discussion: Small fistulas can close spontaneously, but larger and symptomatic fistulas may require closure by surgical or transcatheter methods. Surgical treatment should be considered in patients who are symptomatic, have significant aneurysmal enlargement, and in whom transcatheter occlusion methods have failed.

Conclusion: In patients with CAF, early surgery is a good option to avoid potential complications, and surgical closure can be performed with very low morbidity and mortality rates.