Acute coronary syndrome with rare coincidence of bilateral coronary artery-pulmonary artery fistulas a case report

Khandenahally Shankarappa Ravindranath, Abdul Rehaman, Harmanpreet Singh, Satish Karur
2020 Journal of Xiangya Medicine  
Coronary artery fistulas (CAFs) are rare anomalies encountered in 0.1-0.2% angiographic series. Bilateral coronary pulmonary arterial fistulas (CPAFs) are very rare. CAFs are usually discovered incidentally on coronary angiogram (CAG). Most of them are asymptomatic, ischemic symptoms may develop but are rare in patients with no atherosclerotic disease. CAFs can cause various symptoms due to hemodynamic consequences or complications. Treatment is indicated if they are hemodynamically significant
more » ... mically significant or if secondary complications develop. We report a rare case of 65 years male diabetic patient with bilateral CPAF presented with acute coronary syndrome ST elevation myocardial infarction (STEMI). Patient was treated with fibrinolytic agent followed by CAG done which showed significant lesion in the proximal left anterior descending (LAD) artery with bilateral CPAF from left main (LM), proximal LAD artery and right coronary artery (RCA) to main pulmonary artery. Percutaneous coronary intervention (PCI) with drug eluting stent (DES) to LAD artery was performed. CT CAG was done following PCI which showed bilateral CPAF. Bilateral CPAF was hemodynamically insignificant (normal pulmonary artery pressure and Qp/Qs:1.2) hence conservative management was adviced. This is a rare case of atherosclerotic coronary artery disease presenting as STEMI with bilateral coronary pulmonary artery fistula.
doi:10.21037/jxym-20-82 fatcat:g4yuqbpc4nchlkq3vw4s5rxeoi