Cardiac CT Planning of Surgical Treatment of Multiple Coronary-Pulmonary Fistulas With Chronic Coronary Occlusion.

Authors

Flavia Nicoli, Laura Giroletti, Giuseppe Spira, Elona Collaku, Rocco Mollace, Giorgio Agati, Alessandro Zanello, Alfonso Agnino, Paolo Giulio Giovanni Panisi, Erika Bertella

Published in

JACC. Case reports. Pages 110768. Oct 16, 2026. Epub Oct 16, 2026.

Abstract

Coronary fistulas are rare congenital anomalies that may lead to myocardial ischemia through a coronary steal phenomenon, particularly when associated with coronary artery disease.
We describe a case of cardiac computed tomography angiography (CCTA) diagnosis of multiple coronary-pulmonary artery fistulas associated with chronic occlusion of the right coronary artery, in a 66-year-old man presenting with unstable angina.
CCTA and echocardiography were used for evaluation of procedural planning in an acute setting.
The fistulas were effectively treated with surgical exclusion combined with coronary artery bypass grafting, yielding an optimal result on the postoperative computed tomography scan.
Coronary fistulas are rare but important causes of myocardial ischemia. This case highlights the importance of CCTA definition of anatomical complexity and multidisciplinary decision-making in the management of complex coronary fistulas. Surgical repair remains the preferred approach in complex anatomy cases or associated coronary artery disease requiring revascularization.

PMID:
42886116
Bibliographic data and abstract were imported from PubMed on 16 Oct 2026.

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