A Case of Chest Pain as an Initial
Symptom of Coronary-Pulmonary Arterial Fistula
Kazunori Ishikawa*
Shunichi Hoshino
Hirofumi Midorikawa
Tomohiro Ogawa
Kouichi Sato
(Cardiovascular Center, Fukushima Daiichi Hospital,
Fukushima, Japan)
A 51-year-old woman suffered from
a sudden onset of anterior chest pain and was referred to our
hospital on the suspicion of an anginal attack. The exercise
ECG showed findings of an anterior lesion and ischemia. Coronary
angiography also revealed left anterior descending branch fistula
and circumflex branch fistula connecting to the main pulmonary
artery trunk. Direct closure was performed for both intra-pulmonary
openings under cardiopulmonary bypass. The postoperative course
was uneventful and the patient did not show any precordial pain.
Coronary angiography showed no coronary organic narrowing, but
contrast medium remained in the fistulae although there was no
left to right shunt. Ligation of the fistulae had to be performed
simultaneously to confirm complete obstruction of the coronary-pulmonary
arterial fistulae. The antiplatlet agent is administered to the
patient to prevent occurring myocardial infarction caused by
thrombus which might be formed in fistulae.
Jpn. J. Cardiovasc. Surg. 31：187-190（2002)
