Święch Paweł, Jaźwiec Przemysław, Błaszkiewicz Paweł, Bazan Andrzej
Specialist Medical Center, Polanica Zdrój, Poland.
Jan Mikulicz-Radecki University Hospital, Wrocław, Poland.
Eur J Case Rep Intern Med. 2025 May 16;12(6):005345. doi: 10.12890/2025_005345. eCollection 2025.
Coronary artery fistulas are usually asymptomatic anomalies diagnosed most often incidentally during conventional coronary angiography or computed tomography angiography (CTA) of the coronary arteries.
We present the case of a 74-year-old woman with exertional dyspnoea, preserved left ventricular systolic function, no hemodynamically significant coronary artery stenosis, and a fistula between the anterior interventricular branch of the left anterior descending artery and the pulmonary trunk, identified by classic coronary angiography and CTA.
The growing prevalence of CTA examination of the coronary arteries in recent years has increased the recognition of coronary fistulas. Early diagnosis and appropriate management are essential in symptomatic patients.
Coronary artery fistulas, though rare, should be considered in the differential diagnosis of unexplained exertional dyspnoea, especially in elderly patients with comorbidities.Angio-computed tomography scan is the most effective imaging modality for identifying coronary artery fistulas and assessing their hemodynamic significance.Early diagnosis and appropriate intervention can prevent complications such as coronary steal syndrome, heart failure, and pulmonary hypertension, highlighting the importance of multidisciplinary management. Early recognition of coronary steal syndrome is crucial in symptomatic patients with exertional dyspnoea and no significant coronary artery stenosis.
冠状动脉瘘通常是无症状的异常情况，最常于常规冠状动脉造影或冠状动脉计算机断层扫描血管造影（CTA）时偶然发现。
我们报告一例74岁女性患者，有劳力性呼吸困难，左心室收缩功能正常，无血流动力学意义的冠状动脉狭窄，经经典冠状动脉造影和CTA检查发现左前降支前室间支与肺动脉主干之间存在瘘管。
近年来冠状动脉CTA检查的普及提高了对冠状动脉瘘的认识。对有症状的患者进行早期诊断和适当治疗至关重要。
冠状动脉瘘虽罕见，但在不明原因劳力性呼吸困难的鉴别诊断中应予以考虑，尤其是合并症的老年患者。血管计算机断层扫描是识别冠状动脉瘘及其血流动力学意义的最有效成像方式。早期诊断和适当干预可预防冠状动脉窃血综合征、心力衰竭和肺动脉高压等并发症，凸显多学科管理的重要性。对有劳力性呼吸困难且无明显冠状动脉狭窄的有症状患者，早期识别冠状动脉窃血综合征至关重要。
