Case Report Fistula Coronary and Coronary Steal Syndrome: A Case Report

A coronary artery fistula (CAF) is an aberrant vascular contact of coronary arteries with cardiac chambers or any section of the pulmonary or systemic circulation, which accounts for 0.3% of congenital heart disorders. CAFs have been observed to be as common as 0.9% at computed tomographic (CT) angiography, which is greater than the previously estimated prevalence of 0.002 – 0.3% at invasive angiography. Case Summary: A 76-year-old woman reported with repeated episodes of chest pain. A considerable diameter of fistula from the proximal LAD and proximal RCA to the MPA was discovered on CT angiography, which could be the cause of coronary steal syndrome. Microflex10 7 mm/22 cm was used to perform coil embolization at the proximal RCA. After the procedure, the patient had no more chest pain. Discussion: CT angiography is useful for determining coronary architecture and guiding therapeutic intervention. CAF data was gathered during pre-and post-procedural CT angiography evaluations.


Introduction
Cardiovascular computed tomography, which can rule out coronary artery disease and reveal other coronary anomalies, could be used as a first-line test in low-intermediate risk individuals. Coronary artery fistulas (CAF)s are rare coronary artery anomalies that make up 0.3% of all congenital heart disorders. The prevalence of CAFs found during computed tomographic (CT) angiography has been reported as high as 0.9%, which is higher than the previously estimated prevalence of 0.002-0.3% during invasive angiography. In adults, CAFs can alter hemodynamic parameters and cause problems such as heart failure, myocardial ischemia, infective endocarditis, and arrhythmia [1,2] .
CT coronary angiography (CTCA) has developed as a rapid, accurate, reliable, and noninvasive three-dimensional imaging method for simultaneously examining coronary artery anatomy and surrounding tissues, thanks to significant advancements in temporal and spatial resolution. [3] CAFs are a rare source of chest pain; they're usually asymptomatic and discovered by chance, thus the existence of symptoms can make diagnosis more difficult [4] . B-blockers and calcium channel blockers may help reduce symptoms in have an interventional procedure performed [5] .

ARTICLE INFO
Patients with a single narrow drainage site, a proximal fistula origin, no multiple fistulas or large branch vessels, and/or no associated cardiac problems are increasingly opting for coil embolization for Complex Coronary artery to Pulmonary artery fistulas. [6] Case Illustration

Discussion
The RCA appears to be responsible for 55 percent also help detect post-procedural problems such as recanalization, thrombosis, or device migration. [3,7] In terms of radiation dose and diagnostic precision, CTCA outperforms cardiac catheterization. CTCA takes less time than catheterization and avoids the hazards and difficulties that come with it. CTCA may be more favorable than conventional coronary angiography for accurate diagnosis and therapeutic planning of coronary abnormalities. [8] In Complications during coiling include rupture of the vessel, coil migration, entrapment of guidewire, and death. [4,9,10] September 2022 | Vol 3 | Article 3 Transcatheter embolization and surgical ligation had equal early efficacy, morbidity, and mortality.
The essential criteria for embolization were the proximal placement of the fistulous vascular, older patient age, extra-anatomic termination of the fistula away from the normal coronary arteries, a single drain site, and the absence of accompanying cardiac tissues requiring surgical intervention. [1,9] Specialized imaging, such as cardiac CT, helps Our patient showed signs of coronary steal syndrome; thus, an intervention was necessary.
Historically, coronary artery fistulas were treated with surgery, especially if the patient had coronary artery disease. Because this patient had non-significant stenosis at the proximal LAD and proximal RCA, percutaneous coil embolization was chosen instead of surgery to prevent the dangers of surgery. [1,9] Conclusion CAFs, or coronary artery abnormalities, are a very uncommon type of heart abnormality. Although standard angiography has been used for coronary artery assessment, cross-sectional imaging is a noninvasive and valuable tool for diagnosing CAFs.
CTCA is a noninvasive imaging technique used to define the CAF anatomy better. In addition, optimal CTCA images can be acquired with contrast volumes that are comparable to or lower than those used in conventional coronary angiography.