Left Coronary Artery—Right Ventricle Fistula Case Report: Optimal Treatment Decision
Coronary artery fistulas (CAFs) are rare congenital anomalies, presenting in 0.05–0.9% of cases, characterized by an aberrant connection between a coronary artery and a cardiac chamber or great vessel. Clinical manifestations can include heart failure, myocardial ischemia due to coronary steal, arrh...
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2025-01-01
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| author | Stefan Veljković Ana Peruničić Jovana Lakčević Armin Šljivo Dragana Radoičić Mihajlo Farkić Darko Boljević Jelena Kljajević Milovan Bojić Aleksandra Nikolić |
| author_facet | Stefan Veljković Ana Peruničić Jovana Lakčević Armin Šljivo Dragana Radoičić Mihajlo Farkić Darko Boljević Jelena Kljajević Milovan Bojić Aleksandra Nikolić |
| author_sort | Stefan Veljković |
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| description | Coronary artery fistulas (CAFs) are rare congenital anomalies, presenting in 0.05–0.9% of cases, characterized by an aberrant connection between a coronary artery and a cardiac chamber or great vessel. Clinical manifestations can include heart failure, myocardial ischemia due to coronary steal, arrhythmias, or infective endocarditis. We report a case of a 39-year-old man initially evaluated in 2016 for peripheral edema and suspected right ventricular (RV) abnormality. Earlier assessments indicated a left anterior descending (LAD) coronary artery–RV fistula, but initial catheterization was nondiagnostic. Transthoracic echocardiography (TTE) revealed a dilated left coronary artery (LCA) and an RV apex aneurysm, confirmed by CT and coronary angiography, showing a 14 mm LAD fistula with large aneurysmal sacs (45.6 × 37.3 mm). Cardiac MRI demonstrated a tortuous LAD fistula draining into RV aneurysmal sacs with preserved biventricular function. Surgical intervention was recommended, but the patient declined and was lost to follow-up until 2022, being asymptomatic. Re-evaluation showed progression in aneurysm size (47 × 45 mm and 16 × 18 mm) without ventricular functional change. Follow-up TTE in 2023 indicated stable findings. This case emphasizes the necessity of multimodal imaging (TTE, CT, MRI, angiography) for CAF diagnosis and management planning. Given the variability in CAF presentation and outcomes, individualized management—including surgical, percutaneous, or conservative strategies—is crucial. Persistent follow-up is essential for monitoring potential complications and guiding treatment, even in asymptomatic patients refusing intervention. |
| format | Article |
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| institution | Kabale University |
| issn | 1010-660X 1648-9144 |
| language | English |
| publishDate | 2025-01-01 |
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| series | Medicina |
| spelling | doaj-art-df5eb7c376814509b493d21814a209042025-01-24T13:40:25ZengMDPI AGMedicina1010-660X1648-91442025-01-016115610.3390/medicina61010056Left Coronary Artery—Right Ventricle Fistula Case Report: Optimal Treatment DecisionStefan Veljković0Ana Peruničić1Jovana Lakčević2Armin Šljivo3Dragana Radoičić4Mihajlo Farkić5Darko Boljević6Jelena Kljajević7Milovan Bojić8Aleksandra Nikolić9Cardiovascular Institute “Dedinje”, 111040 Belgrade, SerbiaCardiovascular Institute “Dedinje”, 111040 Belgrade, SerbiaCardiovascular Institute “Dedinje”, 111040 Belgrade, SerbiaDepartment of Cardiosurgery, Clinical Center of University of Sarajevo, 71000 Sarajevo, Bosnia and HerzegovinaCardiovascular Institute “Dedinje”, 111040 Belgrade, SerbiaCardiovascular Institute “Dedinje”, 111040 Belgrade, SerbiaCardiovascular Institute “Dedinje”, 111040 Belgrade, SerbiaCardiovascular Institute “Dedinje”, 111040 Belgrade, SerbiaCardiovascular Institute “Dedinje”, 111040 Belgrade, SerbiaCardiovascular Institute “Dedinje”, 111040 Belgrade, SerbiaCoronary artery fistulas (CAFs) are rare congenital anomalies, presenting in 0.05–0.9% of cases, characterized by an aberrant connection between a coronary artery and a cardiac chamber or great vessel. Clinical manifestations can include heart failure, myocardial ischemia due to coronary steal, arrhythmias, or infective endocarditis. We report a case of a 39-year-old man initially evaluated in 2016 for peripheral edema and suspected right ventricular (RV) abnormality. Earlier assessments indicated a left anterior descending (LAD) coronary artery–RV fistula, but initial catheterization was nondiagnostic. Transthoracic echocardiography (TTE) revealed a dilated left coronary artery (LCA) and an RV apex aneurysm, confirmed by CT and coronary angiography, showing a 14 mm LAD fistula with large aneurysmal sacs (45.6 × 37.3 mm). Cardiac MRI demonstrated a tortuous LAD fistula draining into RV aneurysmal sacs with preserved biventricular function. Surgical intervention was recommended, but the patient declined and was lost to follow-up until 2022, being asymptomatic. Re-evaluation showed progression in aneurysm size (47 × 45 mm and 16 × 18 mm) without ventricular functional change. Follow-up TTE in 2023 indicated stable findings. This case emphasizes the necessity of multimodal imaging (TTE, CT, MRI, angiography) for CAF diagnosis and management planning. Given the variability in CAF presentation and outcomes, individualized management—including surgical, percutaneous, or conservative strategies—is crucial. Persistent follow-up is essential for monitoring potential complications and guiding treatment, even in asymptomatic patients refusing intervention.https://www.mdpi.com/1648-9144/61/1/56coronary artery fistulamultimodal imagingcongenital heart anomalylong-term follow up |
| spellingShingle | Stefan Veljković Ana Peruničić Jovana Lakčević Armin Šljivo Dragana Radoičić Mihajlo Farkić Darko Boljević Jelena Kljajević Milovan Bojić Aleksandra Nikolić Left Coronary Artery—Right Ventricle Fistula Case Report: Optimal Treatment Decision Medicina coronary artery fistula multimodal imaging congenital heart anomaly long-term follow up |
| title | Left Coronary Artery—Right Ventricle Fistula Case Report: Optimal Treatment Decision |
| title_full | Left Coronary Artery—Right Ventricle Fistula Case Report: Optimal Treatment Decision |
| title_fullStr | Left Coronary Artery—Right Ventricle Fistula Case Report: Optimal Treatment Decision |
| title_full_unstemmed | Left Coronary Artery—Right Ventricle Fistula Case Report: Optimal Treatment Decision |
| title_short | Left Coronary Artery—Right Ventricle Fistula Case Report: Optimal Treatment Decision |
| title_sort | left coronary artery right ventricle fistula case report optimal treatment decision |
| topic | coronary artery fistula multimodal imaging congenital heart anomaly long-term follow up |
| url | https://www.mdpi.com/1648-9144/61/1/56 |
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