Conus Branch Fistula to Main Pulmonary Artery: A Rare Coronary Anomaly that May Cause Chest Pain in a Pediatric Patient.

UNLABELLED: Coronary artery fistulas (CAFs) are rare congenital coronary anomalies where abnormal communication develops between coronary arteries and cardiac chambers or a thoracic great vessel. CAF is usually diagnosed incidentally with cardiac imaging. Although the majority of fistulas are congenital, iatrogenic CAFs are increasingly observed due to multiple cardiac interventions or direct chest trauma. CAFs in children may result in hemodynamically significant problems due to vascular shunting. We report an 11-year-old boy who presented with atypical chest pain and was found to have a rare variant of CAF; fortunately, he had no significant hemodynamic complications.

LEARNING POINTS: Coronary artery fistula is a rare anomalous connection between the coronary artery and any segment of the systemic or pulmonary circulation and is usually an incidental finding on cardiac imaging.Echocardiography, computed tomography coronary angiography, cardiac magnetic resonance imaging, and conventional coronary angiography are the tools that provide detailed anatomical visualization to confirm vascular connections in addition to the assessment of hemodynamic consequences resulting from the shunt.A coronary fistula between a separately originating conus branch and the main pulmonary artery is a very rare variation in paediatric practice that may be a cause of chest pain in children.