Arq. Bras. Cardiol. 2019; 112(2): 211-213

Large Bilateral Coronary Artery Fistula: 10-year Follow-up in Clinical Treatment

Rodrigo Melo Kulchetscki , Luka David Lechinewski, Luciana Oliveira Cascaes Dourado, Whady Armindo Hueb, Luiz Antonio Machado César

DOI: 10.5935/abc.20180267

Case Report

A 59-year-old asymptomatic female patient, with a diagnosis of a large bilateral coronary-pulmonary artery fistula made in 2007 was investigated after a cardiac murmur was identified on a routine examination. At the time, conservative treatment was chosen. Cardiac auscultation showed a more audible systolic-diastolic murmur in the upper left sternal border, with a more audible component in systole. There were no other findings in the cardiological physical examination or even the overall segmental examination. The patient had no comorbidities at the time, except for a prior history of smoking (10-pack-years). During the evolution, at the annual outpatient follow-up, she had diagnoses of dyslipidemia, glucose intolerance and depression. At the last consultation, in 2017, the patient was asymptomatic. She used atenolol 25 mg/ day, metformin 850 mg/day, atorvastatin 20 mg/day and sertraline 50 mg/day.

The examinations performed after 10 years of follow-up were compared with those at the time of diagnosis. The current echocardiogram showed right coronary (RC) with 4 mm of diameter at the origin and 7 mm in the middle third; the left main coronary artery (LMCA) with 8 mm. The patient had a fistulous trajectory with tortuous flow communicating both coronaries with the pulmonary trunk, without the presence of pulmonary hyperflow. Additionally, the evolution of mitral regurgitation showed to be of an important degree. shows the echocardiographic parameters during follow-up.

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