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Apr 05,2023

A case report of coronary pulmonary artery fistula detected by transthoracic echocardiography in an elderly patient with dysp

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


  • 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.


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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