Myocardial ischemia due to a coronary-to-pulmonary artery fistula proximal to an intermediate stenosis in the left anterior descending coronary artery: percutaneous closure by means of angioplasty and stent grafting.
This case report refers to a 46-year-old patient with symptomatic stable angina and myocardial ischemia documented at 99mTc-MIBI SPECT scintigraphy. Coronary angiography revealed a coronary artery fistula (CAF) and a non-significant stenosis of the left anterior descending coronary artery (LAD). We performed coronary angioplasty and stenting of the LAD and closure of the CAF using a covered stent. After the procedure the patient was asymptomatic and a myocardial scintigraphy, performed 6 months later, confirmed the absence of myocardial ischemia. This suggests that a CAF arising before a coronary stenosis may contribute to the genesis of myocardial ischemia, perhaps by giving rise to a steal phenomenon.
Galassi
Alfredo R
AR
Clinical Division of Cardiology, University of Catania, Catania, Italy. argalassi@virgilio.it
Grasso
Carmelo
C
Lettica
Elisa
E
Sgroi
Carmelo
C
Cerrito
Marco
M
Tamburino
Corrado
C
D015906:Angioplasty, Balloon, Coronary; D001159:Arterio-Arterial Fistula / Q000150:complications* / Q000628:therapy; D023921:Coronary Stenosis / Q000150:complications*; D003330:Coronary Vessel Anomalies / Q000150:complications* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000209:etiology*; D011651:Pulmonary Artery / Q000002:abnormalities*; D011859:Radiography; D015607:Stents