article · European Heart Journal - Case Reports
Coronary artery fistulas are rare vascular anomalies that can trigger thrombotic complications and heart attacks, presenting diagnostic and therapeutic difficulties due to their variable anatomy and low prevalence. A twenty-nine-year-old man experienced an inferior ST-segment elevation myocardial infarction five days after undergoing orthognathic surgery. Emergency coronary angiography identified a thrombotic blockage in the distal right coronary artery alongside a thrombotic fistula arising from the proximal artery. Successful stenting restored distal coronary flow. Subsequent cardiac computed tomography angiography confirmed a fistula connecting the right coronary artery to the superior vena cava, containing a thrombus. The patient was treated with dual antiplatelet therapy and anticoagulation. Follow-up imaging at three months demonstrated that the right coronary artery stent remained patent while the fistula showed persistent occlusion, highlighting the role of advanced imaging and collaborative clinical management.
Heart attacks in young adults can stem from unusual anatomical defects rather than typical cardiovascular disease. Recognising that rare coronary artery fistulas can form blood clots helps clinicians identify unexpected risks after surgery. This demonstrates the critical role of advanced cardiac computed tomography imaging and multidisciplinary medical teams in correctly diagnosing complex vascular structures and selecting appropriate treatment strategies.
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Background: Coronary artery fistulas are rare coronary anomalies that can occasionally lead to thrombotic complications and myocardial infarction. Their diagnosis and management remain challenging due to variable anatomy and low prevalence. Case summary: A 29-year-old man presented with inferior ST-segment elevation myocardial infarction 5 days after orthognathic surgery. Coronary angiography revealed a thrombotic occlusion of the distal right coronary artery (RCA) and a thrombotic fistula arising from the proximal RCA. Successful stenting restored distal flow. Cardiac computed tomography angiography confirmed a RCA-superior vena cava fistula containing thrombus. The patient received dual antiplatelet therapy and anticoagulation. Follow-up imaging at 3 months showed a patent RCA stent and persistent occlusion of the fistula. Discussion: This case illustrates that coronary artery fistulas, though rare, can lead to acute myocardial infarction in young adults. Coronary computed tomography angiography is essential for anatomical assessment, and heart team discussion is key for individualized management.
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DOI: 10.1093/ehjcr/ytag612
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