A Case of Chest Pain as an Initial Symptom of Coronary-Pulmonary Arterial Fistula

Kazunori Ishikawa* Shunichi Hoshino Hirofumi Midorikawa
Tomohiro Ogawa Kouichi Sato

(Cardiovascular Center, Fukushima Daiichi Hospital, Fukushima, Japan)

A 51-year-old woman suffered from a sudden onset of anterior chest pain and was referred to our hospital on the suspicion of an anginal attack. The exercise ECG showed findings of an anterior lesion and ischemia. Coronary angiography also revealed left anterior descending branch fistula and circumflex branch fistula connecting to the main pulmonary artery trunk. Direct closure was performed for both intra-pulmonary openings under cardiopulmonary bypass. The postoperative course was uneventful and the patient did not show any precordial pain. Coronary angiography showed no coronary organic narrowing, but contrast medium remained in the fistulae although there was no left to right shunt. Ligation of the fistulae had to be performed simultaneously to confirm complete obstruction of the coronary-pulmonary arterial fistulae. The antiplatlet agent is administered to the patient to prevent occurring myocardial infarction caused by thrombus which might be formed in fistulae.@
@Jpn. J. Cardiovasc. Surg. 31F187-190i2002)