JACC. Case reports · 2026
First Diagonal to Left Ventricle Fistula With LAD Collateral Flow: An Unusual Coronary Detour.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Stephan Johnathan, Uddin Mohammed, Woods Everett, Zughaib Marcel
Аннотация
BACKGROUND: Coronary artery fistulas are rare vascular anomalies connecting a coronary artery to a cardiac chamber or vessel. While typically associated with ischemia via coronary steal, they can paradoxically serve a protective role.
CASE SUMMARY: We present a 57-year-old Asian male with 2 weeks of effort angina who was found to have an elevated high-sensitivity troponin. Urgent coronary angiography revealed a 100% mid left anterior descending artery (LAD) occlusion with collateral flow supplied predominantly by a fistulizing first diagonal artery (D1) communicating with the left ventricle.
DISCUSSION: The D1 fistula branches provided critical left-to-left collateral perfusion to the occluded LAD territory, likely limiting ischemic burden and preserving ventricular function. The LAD was successfully recanalized with drug-eluting stent placement, and percutaneous transluminal coronary angioplasty of the D1 was performed.
TAKE-HOME MESSAGE: This case demonstrates that coronary artery fistulas are not inherently pathological and highlights the importance of individualized anatomical assessment when planning coronary interventions.
CASE SUMMARY: We present a 57-year-old Asian male with 2 weeks of effort angina who was found to have an elevated high-sensitivity troponin. Urgent coronary angiography revealed a 100% mid left anterior descending artery (LAD) occlusion with collateral flow supplied predominantly by a fistulizing first diagonal artery (D1) communicating with the left ventricle.
DISCUSSION: The D1 fistula branches provided critical left-to-left collateral perfusion to the occluded LAD territory, likely limiting ischemic burden and preserving ventricular function. The LAD was successfully recanalized with drug-eluting stent placement, and percutaneous transluminal coronary angioplasty of the D1 was performed.
TAKE-HOME MESSAGE: This case demonstrates that coronary artery fistulas are not inherently pathological and highlights the importance of individualized anatomical assessment when planning coronary interventions.