Anesthetic implications for coexisting cardiac capillary hemangioma and multiple coronary artery to pulmonary artery fistulas

Abnormalities of the coronary vascular branches and cardiac hemangiomas represent together unusual clinical entities, with an incidence difficult to establish for the former as the vast majority of the patients with these anomalous vascular connections are usually asymptomatic and 2.8% for the latter. Symptomatic patients may develop dyspnea on exertion or chest pain secondary to a "coronary steal" phenomenon as part of the underlying pathophysiology of the disease. The authors report a case of a patient with concomitant cardiac capillary hemangioma with multiple coronary to pulmonary artery fistula connections that was successfully treated with surgical resection of the tumor and ligation of the fistula tracts. A comprehensive and balanced anesthesia management aimed to preserve tight hemodynamic stability to avoid increased myocardial demand and worsening of the coronary steal becomes essential in these patients.