2025, Number 1
Cardiovasc Metab Sci 2025; 36 (1)
Coronary artery to right pulmonary artery fistula in an adolescent
Gomez-Vargas, Juan; Gutierrez-Fajardo, Pedro; Baeza, Frank A
ABSTRACT
Coronary artery fistulas (CAF) represent a rare category of congenital anomalies that are frequently underdiagnosed due to the absence of early-life symptomatology. Most cases of CAF are incidentally discovered during imaging examinations conducted for unrelated medical issues. Given the diverse presentation and potential severity of CAF progression, early screening is warranted, as irreversible cardiac remodeling may occur. Some fistulas may be large in the newborn period, but others may increase in size over time. The most substantial shunts typically occur in those fistulas where the coronary artery communicates with the right side of the heart rather than the left, which may result in symptoms of congestive heart failure, particularly in infants and occasionally in newborns. Furthermore, there have been instances of similar presentations in the elderly. Additionally, there exists a risk of thrombosis within these fistulas, which can lead to severe complications such as acute myocardial infarctions, paroxysmal fibrillation, and ventricular arrhythmias. A multimodal evaluation is crucial for achieving an accurate diagnosis at an earlier stage in life. This report presents the case of a 13-year-old female gymnast who sought medical evaluation due to palpitations.