Spontaneous Near Disappearance of Bilateral Coronary ArteryPulmonary Artery Fistulas* Satoshi Ncikcltani, !II.D.; Shir~Yuke Nanto, 1\t.D.; Tohro Masuyanw, !II.D.; fun Tanwi, M.D. ; and Ka::.uh~w1 KadaTTUI, !II.D.
coronary artery fistulas; they may have a distinct embryologic entity.' The natural course and prognosis of bilateral coronary artery-pulmonary artery fistulas are little known. We report the unique case of a patient whose bilateral coronary artery-pulmonary artery fistulas almost disappeared spontaneously in the course of four years. CASE REPORT
A1though coronary artery fistula is a relatively rare anomaly, it sometimes develops with advancing age, requiring surgical removal. We report a unique case of a patient whose bilateral coronary artery-pulmonary artery fistulas nearly disappeared in the course of four years. This case is interesting in view of recognizing one of the natural courses of this entity. (Chest 1991; 99:1288-89)
C
oronary artery fistula is a relatively rare anomaly with an incidence of 0.07 percent to 0.20 percent. '·2 Bilateral coronary artery-pulmonary artery fistulas are especially uncommon, accounting for only 5 percent of the total *From the Cardiovascular Division, Osaka Police Hospital, Osaka, Japan.
Reprint requests: Dr. Nakatani, Cardiology Divisicm, Natiooal Cardiovascular Center; 4-7-1 Fujishiro-dai , Suit a, Osaka .56.5. japan
A 5.'5-year-old man was first seen with a l"mplaint of exertional atypical chest discomfort. II is only cardiac risk factor was smoking. Findings from physical examination were not remarkable, and no murmur was heard on auscultation. Chest roentgenography showed no sign of cardiac enlargement or pulmonary hypertension. His electrocardiogram was normal. Cardiac catheterization was performed to rule out coronary artery disease. The intracardiac pressures were all normal and an oxygen saturation nm revealed no evidence of a significant left-to-right shunt. The left and right l"rmmunicated to the separated l•mus artery \\ith the right side of the main pulmonary artery and the other wmmunicated to the left main l"ronary artery with the left side of the main pulmonary artery (Fig 1). Since there was no evidence of a significant shunt, he did not undergo mrrective surgery and was discharged from the hospital. Four years later. although his electrocardiogram and chest roent-
FIGl'RE l. Coronary angiograms at the first cardiac catheterization. A: The separated l•mus artery angiogram in the 30° right anterior oblique projection. B: The left coronary artery angiogram in the 30° right anterior oblique pmjection. C: The separated mnus artery angiogram in the 60° left anterior oblique projection. D: The left l~>ronary artery angiogram in the 55° left anterior oblique and 25° craniocaudal projection . Arrows indicate fistulas.
1288
Near Disappearance
ol Coronary-Pulmonary Artery FIStUlas (Nakatani et 81)
Flt:l'HE 2. Coronary an!!:io!!:rams at the fi>llow-up cardiae catheterization. A: The separated conus artery an!!:iogram in the :30° right anterior obli
coronary artery fistulas; they may have a distinct embryologic entity.' The natural course and prognosis of bilateral coronary artery-pulmonary artery fistulas are little known. We report the unique case of a patient whose bilateral coronary artery-pulmonary artery fistulas almost disappeared spontaneously in the course of four years. CASE REPORT
A1though coronary artery fistula is a relatively rare anomaly, it sometimes develops with advancing age, requiring surgical removal. We report a unique case of a patient whose bilateral coronary artery-pulmonary artery fistulas nearly disappeared in the course of four years. This case is interesting in view of recognizing one of the natural courses of this entity. (Chest 1991; 99:1288-89)
C
oronary artery fistula is a relatively rare anomaly with an incidence of 0.07 percent to 0.20 percent. '·2 Bilateral coronary artery-pulmonary artery fistulas are especially uncommon, accounting for only 5 percent of the total *From the Cardiovascular Division, Osaka Police Hospital, Osaka, Japan.
Reprint requests: Dr. Nakatani, Cardiology Divisicm, Natiooal Cardiovascular Center; 4-7-1 Fujishiro-dai , Suit a, Osaka .56.5. japan
A 5.'5-year-old man was first seen with a l"mplaint of exertional atypical chest discomfort. II is only cardiac risk factor was smoking. Findings from physical examination were not remarkable, and no murmur was heard on auscultation. Chest roentgenography showed no sign of cardiac enlargement or pulmonary hypertension. His electrocardiogram was normal. Cardiac catheterization was performed to rule out coronary artery disease. The intracardiac pressures were all normal and an oxygen saturation nm revealed no evidence of a significant left-to-right shunt. The left and right l"rmmunicated to the separated l•mus artery \\ith the right side of the main pulmonary artery and the other wmmunicated to the left main l"ronary artery with the left side of the main pulmonary artery (Fig 1). Since there was no evidence of a significant shunt, he did not undergo mrrective surgery and was discharged from the hospital. Four years later. although his electrocardiogram and chest roent-
FIGl'RE l. Coronary angiograms at the first cardiac catheterization. A: The separated l•mus artery angiogram in the 30° right anterior oblique projection. B: The left coronary artery angiogram in the 30° right anterior oblique pmjection. C: The separated mnus artery angiogram in the 60° left anterior oblique projection. D: The left l~>ronary artery angiogram in the 55° left anterior oblique and 25° craniocaudal projection . Arrows indicate fistulas.
1288
Near Disappearance
ol Coronary-Pulmonary Artery FIStUlas (Nakatani et 81)
Flt:l'HE 2. Coronary an!!:io!!:rams at the fi>llow-up cardiae catheterization. A: The separated conus artery an!!:iogram in the :30° right anterior obli
