Coronary Artery Fistulas: Symptoms may not Correlate to Size. An Emblematic Case and Literature Review.

<p>Coronary artery fistulas are rare anatomic abnormalities of the coronary arteries present in 0.002% of the general population and represent 14% of all anomalies of coronary arteries. Their clinical relevance focuses mainly on the mechanism of "coronary steal phenomenon”, causing myocardial functional ischemia even in the absence of stenosis, hence common symptoms are angina or dyspnea. Small size fistulas are mostly asymptomatic and have excellent prognosis if managed medically with regular follow-up consisting also in echocardiography every 2-5 years. Big-sized and symptomatic fistulas, on the contrary, should undergo invasive closure, either with a transcatheter approach or with surgical ligation, whose results are equivalent at long-term follow-up. However, in some cases, symptoms may not correspond with size. Larger fistulas may be asymptomatic and very small fistulas may cause symptoms like angina in our patient. Here, we are presenting an emblematic and very rare case with a complete literature review. Particularly, very didactic angiography images and then during surgery are shown. </p>