Giant Coronary Fistula to Left Ventricle

32. Uluslararası Katılımlı Türk Kardiyoloji Kongresi, Antalya, Türkiye, 20 - 23 Ekim 2016, ss.8

Coronary artery fistulas are rarely seen and they have been identified for the first time in 1865.

More than half of them are originated from the right coronary artery. Only a few fistula drain into

the left side of the heart. Fistulas can be congenital or acquired due to trauma or surgery. 62-yearold

woman who underwent surgical closure of atrial septal defect 40 years ago presented with

dyspnea, atypical chest pain and pretibial edema for almost one week. A grade 4/6 systolic murmur

was heard at mitral area and apex. The symptoms and other physical examination findings thought

to be consistent with heart failure. An electrocardiogram showed atrial fibrillation and there was no

ischemic evidence. Transthoracic echocardiography revealed severe mitral and tricuspid regurgitation

and left ventricular ejection fraction of 64%. Since the patient described chest pain, coronary

angiography was performed before surgery. Left anterior descending artery was extremely aneurismatic

and tortuous, and a fistula was found between left anterior descending artery and left ventricle.

After signs and symptoms of heart failure improved, the patient was transferred to surgery.

The majority of fistula are congenital and asymptomatic. Symptoms may also occur in relation

to the size of fistula. Only a few of fistula is terminating in the left ventricle. If fistulas drain into

the left ventricle, they may cause hemodynamic results which are similar to aortic insufficiency.

Clinically, myocardial ischemia or high output cardiac failure has been identified due to fistula. In

symptomatic patients, surgical or interventional therapies (coil placement) are available. This case

illustrates a rare extremely tortuous and aneurysmal left anterior descending artery due to coronary

fistula to the left ventricle.