Large coronary artery fistula

We present a case of congestive heart failure with pulmonary artery hypertension caused by a left-to-right shunt. Physical examination on admission revealed hypertension, arrhythmia, a diastolic murmur over the bilateral sternal borders, and a pitting edema over both lower legs. Imaging studies revealed a large coronary artery fistula (CAF). After ligation of the fistula, the patient recovered adequately and was discharged. Although cases of CAF have been reported and clinical presentations such as congestive heart failure are not rare, CAFs require particular attention, because they typically exhibit a varied clinical course. We present this case to share our experience regarding myocardial protection and help practitioners prevent misdiagnosis or delayed treatment for such cases. Copyright (C) 2015, Taiwan Surgical Association. Published by Elsevier Taiwan LLC. All rights reserved.