JACC. Case reports · 2026
Cardiac CT Planning of Surgical Treatment of Multiple Coronary-Pulmonary Fistulas With Chronic Coronary Occlusion.
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Nicoli Flavia, Giroletti Laura, Spira Giuseppe, Collaku Elona, Mollace Rocco, Agati Giorgio, Zanello Alessandro, Agnino Alfonso, Panisi Paolo Giulio Giovanni, Bertella Erika
Аннотация
ANATOMY: Coronary fistulas are rare congenital anomalies that may lead to myocardial ischemia through a coronary steal phenomenon, particularly when associated with coronary artery disease.
PATHOLOGY: We describe a case of cardiac computed tomography angiography (CCTA) diagnosis of multiple coronary-pulmonary artery fistulas associated with chronic occlusion of the right coronary artery, in a 66-year-old man presenting with unstable angina.
IMAGING CORRELATION: CCTA and echocardiography were used for evaluation of procedural planning in an acute setting.
TREATMENT: The fistulas were effectively treated with surgical exclusion combined with coronary artery bypass grafting, yielding an optimal result on the postoperative computed tomography scan.
TAKE-HOME MESSAGES: Coronary fistulas are rare but important causes of myocardial ischemia. This case highlights the importance of CCTA definition of anatomical complexity and multidisciplinary decision-making in the management of complex coronary fistulas. Surgical repair remains the preferred approach in complex anatomy cases or associated coronary artery disease requiring revascularization.
PATHOLOGY: We describe a case of cardiac computed tomography angiography (CCTA) diagnosis of multiple coronary-pulmonary artery fistulas associated with chronic occlusion of the right coronary artery, in a 66-year-old man presenting with unstable angina.
IMAGING CORRELATION: CCTA and echocardiography were used for evaluation of procedural planning in an acute setting.
TREATMENT: The fistulas were effectively treated with surgical exclusion combined with coronary artery bypass grafting, yielding an optimal result on the postoperative computed tomography scan.
TAKE-HOME MESSAGES: Coronary fistulas are rare but important causes of myocardial ischemia. This case highlights the importance of CCTA definition of anatomical complexity and multidisciplinary decision-making in the management of complex coronary fistulas. Surgical repair remains the preferred approach in complex anatomy cases or associated coronary artery disease requiring revascularization.