A Fistula between Coronary and Main Pulmonary Arteries with Chest Tightness

A 64-year-old woman presented to our facility with recurrent chest tightness. Angiography showed a dilated (10 mm) aneurysmal tortuous coronary artery fistula (CAF) to the main pulmonary arterial trunk occupying a large area of the anterior surface of the aortic root. Left and right heart catheterization showed high left-to-right shunt flow. Fissurectomy and coronary artery bypass grafting were performed. The patient had no postoperative complications and became asymptomatic. The outcome of our case shows that CAF should be a differential diagnosis of recurrent symptomatic cardiac ischemia. Intervention is indicated if symptoms or secondary complications develop.