Off-Pump Surgical Epicardial Closure of Left Anterior Descending to Pulmonary Artery Fistula
Background
Coronary artery fistulae (CAF) are rare anomalies. Among them, the left
anterior descending to pulmonary artery is a very unusual occurrence, and those
causing severe ischemic symptoms in that location are exceptional. Large
fistulas create a significant shunt and a "steal phenomenon," and can
lead to myocardial ischemia and heart failure if left untreated.
Case Presentation
The authors present a 57-year-old woman with a left anterior descending to pulmonary
artery fistula, causing progressive and daily ischemic chest pain associated
with dyspnea and dizziness. Diagnosis was performed by coronary angiography and
3D computed tomography imaging reconstruction of the left anterior descending
and pulmonary artery.
Based on the anatomical location and the tortuosity of the
trajectory of the fistula, it was not considered suitable for percutaneous
closure and surgery was decided as the best option. Surgical closure of the
fistula was performed on a beating heart, off-pump. The outcome was favorable
with complete resolution of the ischemic symptoms.
Conclusions
Traditionally, surgery has been the main therapeutic method for the closure of coronary
artery fistulas, with proven efficacy and safety. Transcatheter closure
approaches have emerged as a less invasive strategy and are nowadays considered
a valuable alternative