Surgical Treatment Of A Bilateral Aneurysmatic Aortic/Coronary-To-Pulmonary Fistula Associated Mitral And Tricuspid Valve Regurgitation: A Rare Case Report

Coronary artery fistula is a rare abnormality which may cause severe complications such as congestive heart failure, infective endocarditis and even cardiac tamponade. We report a case of successful surgical treatment of a 63-year-old man with bilateral coronary artery to pulmonary fistulas, complicated by coronary aneurysm, severe mitral regurgitation, tricuspid regurgitation, atrial fibrillation, pulmonary arterial hypertension. We have documented a rare case of CAF arising from bilateral coronary connecting to the pulmonary and concomitant severe MR, TR, AF and PAH. We incised the main pulmonary artery, and a terminal fistula with 4-mm diameter was identified. We closed this fistula with pledgetted mattress sutures using two pairs of 5-0 prolene. Then the thin wall of the aneurysm was partially excised, no addition connection was found, we sutured and reinforced it with 7-0 prolene and opened pulmonary artery was repaired. Through a trans-septal approach, the mitral valve was repaired by using a size 32 Edwards C-E Physio Annuloplasty Ring and the tricuspid was repaired with a size 32 Edwards MC3 Tricuspid Annuloplasty Ring. During operation, no hemodynamic instability was observed. The postoperative course was uneventful and patient was discharged in an excellent condition on postoperative day 8. At six-month follow-up, he was asymptomatic, and the repeat echocardiogram showed a normally sized and functioning heart with normal LVEF (72%), without any residual shunt and valvular regurgitation. In conclusion, due to the rarity of such a condition, the careful assessments and appropriate therapeutic strategies should be tailored to the patients.