Open AccessA Fistula Where? Left Anterior Descending to Pulmonary Artery Fistula
Author(s) -
Samantha Gelman,
Andrew Benin,
Javad Savoj,
Rajesh Gulati,
Kaustubh C. Patankar,
Patrick Hu
Publication year - 2020
Publication title -
journal of medical cases
Language(s) - English
Resource type - Journals
eISSN - 1923-4163
pISSN - 1923-4155
DOI - 10.14740/jmc3527
Subject(s) - medicine , fistula , asymptomatic , pulmonary artery , artery , coronary steal , cardiology , surgery , bronchial artery , left pulmonary artery , radiology , embolization , myocardial infarction , coronary angiography
Fistulas are abnormal passageways between two organs or vessels that usually do not connect. Coronary artery fistulas occur when one of the coronary arteries is connected to either a heart chamber or another blood vessel. This case presents a coronary artery fistula which may or may not be impacting the patient's heart function. A 69-year-old male with multiple comorbidities presents with a chief complaint of shortness of breath. Catheterization reveals an anomalous left anterior descending to pulmonary artery fistula without a step up in oxygen saturation at the level of the pulmonary artery. Surgical management was deferred as this fistula was not deemed to contribute to the patient's declining cardiac function. Operative management versus embolization would be a feasible alternative for patients who are symptomatic secondary to the coronary artery fistula and remains to be controversial in patients who are asymptomatic. Given the possibility of these fistulae eventually causing symptoms it would be practical to close them early on before symptoms arise or before size of the fistulae becomes an issue. Further research should be conducted to understand the management strategies for patients who present with coronary artery fistulas.