Left Anterior Descendent Coronary Artery Fistula to Main Pulmonary Artery with Triple Vessel Disease:A Report of Two Cases
Keywords:Coronary artery fistula, direct pledget suturing, coronary artery disease, triple vessel disease, mitral regurgitation.
Coronary artery fistula is a rare anomaly of coronary artery. It represents connection between one or more of
coronary arteries and cardiac chamber or great vessel. It can also cause significant hemodynamic changes. To
report cases of left anterior descending coronary artery (LAD) fistula to main pulmonary artery (MPA) with
concomitant triple vessel disease.Case 1 was 59-year old male presented with intermittent chest discomfort
for a year. Echocardiogram showed severe MR with cleft at A1 and A2 and coronary angiogram result
showed LAD fistulation to MPA. Case 2 was 57-year old male presented with chest discomfort and at the left
shoulder. Echocardiogram showed trivial MR and coronary angiogram showed triple vessel disease along
with tortuous fistulation of LAD to MPA. Both patients underwent teflonpledget-reinforced direct suturing
of fistula origin and 3-grafts coronary artery bypass graft. Patient no 1 also underwent mitral annuloplasty
and valvuloplasty.Post-operative period was uneventful and both patients were discharged after 17 days and
5 days respectively. Short term follow-up showed improvement of symptoms and no residual fistulation.In
short term follow-up teflonpledget-reinforced direct suturing of coronary fistula origin result satisfactory.
Larger study and further follow up is necessary.
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