title: A large coronary-pulmonary artery fistula in a cyanotic patient leading to severe biventricular dysfunction and heart failure.
abstract: In cases of pulmonary atresia (PA) with ventricular septal defect (VSD), the commonest source of pulmonary blood flow is via major aortoplumonary collaterals. Collaterals may also arise from the coronary arteries and the reported prevalence of such coronary-pulmonary artery fistulas (CPAF) in PA with VSD is 10%. However gross congestive heart failure (CHF) and ventricular dysfunction is extremely rare in such cases. We report a 17-year-old male with PA with VSD and a large CPAF from the anterior right aortic sinus connecting to the left pulmonary artery, who presented with severe CHF. The left anterior descending and the right coronary artery both arose from the proximal part of the CPAF, possibly leading to extensive coronary steal and biventricular dysfunction.
authors.affiliation: Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, India. akapoor65@gmail.com
authors.forename: Aditya
authors.initials: A
authors.lastname: Kapoor
authors.forename: Rohit
authors.initials: R
authors.lastname: Walia
authors.forename: Sunil
authors.initials: S
authors.lastname: Jain
authors.forename: Sudeep
authors.initials: S
authors.lastname: Kumar
mesh_terms: D000293:Adolescent; D001159:Arterio-Arterial Fistula / Q000150:complications* / Q000000981:diagnostic imaging; D003324:Coronary Artery Disease / Q000150:complications* / Q000000981:diagnostic imaging; D003490:Cyanosis / Q000175:diagnosis / Q000209:etiology*; D003937:Diagnosis, Differential; D004452:Echocardiography; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D008297:Male; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D018754:Ventricular Dysfunction / Q000000981:diagnostic imaging / Q000209:etiology*