Apr 05,2023

Thai Truong ¹, Hang Thi Tuyet Nguyen ², Vien Thi Xuan Phan ³, Minh Huong Phu Ly ⁴, Van Thi Tuong Phan ⁵, Tu Anh Phan ⁶, Hannah Hue Phan ⁷, Phillip Tran ⁸

Affiliations

• ¹Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam.
• ²Cho Ray Hospital, Ho Chi Minh City, Vietnam.
• ³Kansai Medical University, Hirakata, Osaka, Japan.
• ⁴Children's Hospital No. 1, Ho Chi Minh City, Vietnam.
• ⁵Jacobi Medical Center, The Bronx, NY, USA.
• ⁶Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam.
• ⁷University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam.
• ⁸Nam Can Tho University, School of Medicine, Can Tho, Vietnam.

• PMID: 33623864
• PMCID: PMC7897550
• DOI: 10.21037/acr-20-100

Abstract

Coronary pulmonary artery fistula (CPAF) is a rare entity in the population. It may present with multiple clinical settings and in various age ranges. Invasive coronary angiography (ICA), coronary computed tomography angiography (CCTA), and transthoracic echocardiography (TTE) have been reported as diagnostic tools for CPAF. Among them, TTE is rarely capable of identifying CPAF. There is no current treatment guideline as some of the interventional therapies are effective yet controversial. The therapy therefore should be individualized. We report a case of CPAF accidentally detected by TTE in a 93-year-old female who presented with acute respiratory distress on the setting of community-acquired pneumonia, diastolic heart failure, ischemic heart disease, pulmonary hypertension, chronic kidney disease, and hypertension. The patient presented with orthopnea, fever, bilateral pleuritic chest pain, and productive cough with yellowish sputum for 7 days. She had no previous chest trauma or surgical intervention. TTE demonstrated the tortuous enlargement of left coronary artery which drains into the pulmonary arterial trunk right above the pulmonary valve. As the patient was in advanced age with multiple comorbidities; we offered a conservative management including diuretic, oxygen therapy, antibiotic, antiplatelet, and statin. She recovered following a 13-day hospitalization. To our knowledge, this is the oldest case report of suspected congenital CPAF which is particularly detected by TTE.

Keywords: Case report; coronary vessel anomaly; echocardiography; myocardial ischemia; pulmonary hypertension.

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