JACC. Case reports · 2026
Multisource Coronary Artery Fistula Draining Into the Coronary Sinus: Multimodality Imaging and Surgical Repair.
Клинический случайСтатьяНазвание и аннотация: Перевод пока не подготовлен
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Trung Nguyen Quang, Dung Le Viet, Minh Ly Nguyen Thi, Tai Mai The, Dat Bui Tuan, Van Diep Pham, Cuong Nguyen Ngoc, Linh Le Tuan
Аннотация
BACKGROUND: Coronary artery fistula (CAF) is a rare congenital coronary anomaly. Multisource CAF draining into the coronary sinus is exceptionally uncommon and anatomically complex.
CASE PRESENTATION: A woman presented with progressive exertional dyspnea and right-sided heart failure. Multimodality imaging, including transthoracic echocardiography, coronary computed tomography angiography, and invasive coronary angiography, demonstrated multisource CAFs arising from the right coronary artery and left circumflex artery draining into the coronary sinus with diffuse aneurysmal coronary dilatation. The patient underwent surgical ligation of the dominant right CAF with concomitant tricuspid annuloplasty. Postoperative imaging demonstrated successful closure of the dominant right CAF with thrombus formation within the ligated fistulous tract, whereas the smaller left circumflex artery fistula persisted, and serial follow-up demonstrated clinical improvement.
CONCLUSION: Multimodality imaging is essential for diagnosis, treatment planning, and postoperative surveillance of complex CAF. Surgical repair remains an effective treatment strategy for anatomically complex fistulas associated with significant hemodynamic consequences.
CASE PRESENTATION: A woman presented with progressive exertional dyspnea and right-sided heart failure. Multimodality imaging, including transthoracic echocardiography, coronary computed tomography angiography, and invasive coronary angiography, demonstrated multisource CAFs arising from the right coronary artery and left circumflex artery draining into the coronary sinus with diffuse aneurysmal coronary dilatation. The patient underwent surgical ligation of the dominant right CAF with concomitant tricuspid annuloplasty. Postoperative imaging demonstrated successful closure of the dominant right CAF with thrombus formation within the ligated fistulous tract, whereas the smaller left circumflex artery fistula persisted, and serial follow-up demonstrated clinical improvement.
CONCLUSION: Multimodality imaging is essential for diagnosis, treatment planning, and postoperative surveillance of complex CAF. Surgical repair remains an effective treatment strategy for anatomically complex fistulas associated with significant hemodynamic consequences.