Acute coronary syndrome in a patient with multiple coronary artery fistulas draining from the left anterior descending artery into the left ventricle – 2-year follow-up

摘要

Coronary artery fistula (CAF) is an abnormal connection between a coronary artery and a chamber of the heart (most often the right ventricle) or a large vessel. Most fistulas remain asymptomatic and are discovered accidentally during coronary artery diagnostics performed for other reasons. It is assumed that clinical symptoms and chest pain or exertional dyspnoea are caused by a steal phenomenon. In the case of coronary artery fistulas therapeutic management depends on clinical manifestation and the significance of haemodynamic consequences caused by the fistula. It should be noted that current guidelines of treatment are based on small retrospective studies. We present a case of a 45-year-old patient with CAF of a rare location draining from the left anterior descending artery into the left ventricle and accompanied by a myocardial bridge narrowing the lumen of this artery. The patient presented with symptoms of acute coronary syndrome.