Coronary-Pulmonary Artery Fistula and critical LAD stenosis: surgical ligation and revascularization.

Coronary-pulmonary artery fistulas are rare congenital anomalies that can lead to significant clinical complications, especially when associated with coronary artery disease. We present a case of a 61-year-old male who presented with progressive dyspnea and chest discomfort. Imaging revealed a coronary-pulmonary artery fistula with 60% stenosis in the proximal left anterior descending artery. Due to the size and complexity of the fistula, along with the need for coronary artery revascularization, the patient underwent surgical ligation of the fistula combined with coronary artery bypass grafting. The patient had an uneventful recovery and was discharged on postoperative Day 6. At the 3-month follow-up, he reported a complete resolution of symptoms. This case illustrates the importance of surgical intervention in managing complex coronary fistulas with associated coronary artery disease and highlights the need for individualized treatment approaches.