A Rare Coronary Anomaly Coincidentally Encountered During Primary Percutaneous Coronary Intervention: A Coronary-Pulmonary Artery Fistula
Coronary-pulmonary artery fistula (CPAF) is one of the coronary anomalies rarely encountered in coronary angiography series. CPAFs are usually congenital but uncommonly remain asymptomatic in the advanced ages. Herein, we aimed to report our approach to a case of CPAF, which remained asymptomatic until advanced ages and was determined coincidentally in a patient undergoing percutaneous intervention for acute anterior myocardial infarction. A 70-year-old male patient, who was admitted to the Emergency Department with extensive chest pain, hypotension, cold sweating, and impaired general status, underwent coronary angiographic intervention after being diagnosed with acute anterior myocardial infarction. During the intervention, a plexiform fistula originated from the conus branch of the right coronary artery and extended to the pulmonary artery was detected coincidentally. The 64-section computed tomography of the thorax confirmed that fistula drained into the left pulmonary artery. Taking the clinical and demographic characteristics of the patient into account, we decided medical follow-up as the first treatment option. Nowadays, coronary fistulas are usually closed by coiling or surgery even they are asymptomatic. We are in the opinion that conservative approach would be more reasonable for asymptomatic fistulas in advanced age patients having additional cardiac pathologies
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