Coronary-Pulmonary Artery Fistula With Aneurysm Formations

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J INVASIVE CARDIOL 2024. doi:10.25270/jic/24.00345. Epub December 23, 2024.

A 51-year-old man presented with palpitations and shortness of breath for the past 4 years. Findings from electrocardiography and laboratory tests performed after physical examination were unremarkable. Coronary computed tomography angiography (CCTA) was performed to rule out coronary heart disease.

The CCTA showed that several large and tortuous vessels originating from the left main coronary artery, the left circumflex artery, and the proximal right coronary artery were connected to the pulmonary artery, forming a coronary-pulmonary artery fistula (CPAF) with the formation of multiple aneurysms (Figure). A bronchial artery from the descending aorta was also involved in the CPAF. Coronary angiography (CAG) confirmed the CCTA findings (Figure, Videos 1-3).

The patient underwent successful coronary artery fistula ligation. The postoperative course was uneventful, and the patient was discharged after 1 week.

CPAF is rare, accounting for about 0.3% of all congenital heart conditions. It may originate from any branch of the coronary artery, and both left and right coronary arteries are involved in about 5% of cases.^1,2 However, CPAF involving 3 coronary and bronchial arteries with the formation of multiple aneurysms is much rarer. CCTA can clearly depict the morphology and position of the fistula, allowing surgeons to evaluate the anatomic delineation, origin, and outflow site of the fistula.

Affiliations and Disclosures

Zhenzhen Xiao, MD; Li Zhu, MD

From the Department of Radiology, Wuhan Asia Heart Hospital Affiliated Wuhan University of Science and Technology, Wuhan, China.

Disclosures: The authors report no financial relationships or conflicts of interest regarding the content herein.

Consent statement: The authors confirm that informed consent was obtained from the patient(s) for the study and/or intervention(s) described in the manuscript and to the publication of their data.

Artificial intelligence disclosure: This manuscript was prepared without the assistance of artificial intelligence (AI) technologies, including but not limited to large language models (LLMs), chatbots, or image creators.

Address for correspondence: Li Zhu, MD, Department of Radiology, Wuhan Asia Heart Hospital Affiliated to Wuhan University of Science and Technology, No.753 Jinghan Road, Hankou District, Wuhan 430022, China. Email: 476695029@qq.com

References:

1. Yun G, Nam TH, Chun EJ. Coronary artery fistulas: pathophysiology, imaging findings, and management. Radiographics. 2018;38(3):688-703. doi:10.1148/rg.2018170158

2. Wang X, Chen T. Cinematic rendering of a coronary-pulmonary artery fistula. Radiology. 2024;311(3):e240159. doi:10.1148/radiol.240159