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Journal of Cardiovascular Medicine and Surgery 12(1):p 21-25, Jan-April 2026. | DOI: 10.21088/jcms.2454.7123.12126.3
Review Article
Left Coronary Artery Fistula Masquerading as Coronary Insufficiency: A Rare Surgical Scenario
Premanand Ponoth, James Kariuki, Antony Gikonyo, Dan Gikonyo, Betty Gikonyo, Shrikant Panchal
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Attribution-Non-commercial 4.0 International (CC BY-NC 4.0)This license enables reusers to distribute, remix, adapt, and build upon the material in any medium or format for noncommercial purposes only, and only so long as attribution is given to the creator.
Journal of Cardiovascular Medicine and Surgery 12(1):p 21-25, Jan-April 2026. | DOI: 10.21088/jcms.2454.7123.12126.3
How Cite This Article:
Premanand Ponoth, James Kariuki, Antony Gikonyo, et al. Left Coronary Artery Fistula Masquerading as Coronary Insufficiency: A Rare Surgical Scenario. Indian J Cardiovasc Med Surg. 2026; 12(1): 21–25.Timeline
Received : February 28, 2026
Accepted : March 29, 2026
Published : April 30, 2026
Abstract
Coronary artery fistulae are rare vascular malformations that occur in less than 0.2 per cent of those who undergo coronary angiography. A scarce type is a fistulous connection of the superior vena cava (SVC) and left circumflex (LCX) artery, which is challenging to diagnose and to treat. 40-year-old woman (para 2+0), normal looking who had exertional angina. Transthoracic echocardiography revealed an intact biventricular status. The ejection fraction of the ventricles was 57%, and had mild left-sided pleural effusion. On stress echocardiography, transient ischemia was detected that was confined to the LCX territory. Ectasia of the left main was later confirmed by coronary angiography, with a direct fistula of the LCX into the SVC. Such fistulae may form under developmental failure of the embryonic coronary connections to regress adequately, or they can be a by-product of trauma, infections, inflammatory diseases or past cardiac operations. Management strategies are using medications, or catheter-based device. Surgical management depend on the exact anatomy of the fistula, and whether the patient has any coronary artery diseases. Presence of angina, the overt presence of inducible ischemia, the large size of the fistula and its location, open surgical ligation was the treatment of choice. The importance of an individual approach to the treatment based on the specifics of the anatomy is vital.
References
- 1. Mangukia C.V. Coronary artery fistula. Ann Thorac Surg. 2012; 93(6): 2084–92.
- 2. Armsby L.R., et al. Coronary artery fistulae: patient selection and outcome. J Am Coll Cardiol. 2002; 39(6): 1026–32. 3.
- 3. Lim J.J., et al. Coronary artery fistula: A complete review of them and imaging findings. Radiographics. 2014; 34(4): 781–94
- 4. Said S.A. What we know about coronary artery f istulas. World J Cardiol. 2011; 3(8): 267–77. 5.
- 5. Raju M.G., et al. Myocardial ischemia in a coronary artery fistula. Clin Cardiol. 2009; 32(11): E39–E43. 6.
- 6. Qureshi S.A. Coronary-artery fistulas. Heart. 2006; 92(12): 1007–12. 7.
- 7. Cheung D.L., et al. Congenital fistulas of the coronary artery: congenital and management. Ann Thorac Surg. 2001; 71(1): 189–91. 8.
- 8. Luo L., et al. Modern results of surgical repair of coronary fistulae. Ann Thorac Surg. 2019; 108(1): 122–28. 9.
- 9. Publix, 2005, p. 1756. Eur Radiol. 2005; 15(6): 1114–20. 10.
- 10. Dodge-Khatami A, et al. Fistulas of the coronary artery: embryology and classification. Ann Thorac Surg. 2000; 70(1): 208–13
Data Sharing Statement
There are no additional data available. All raw data and code are available upon request.
Funding
This research received no funding.
Author Contributions
All authors contributed significantly to the work and approve its publication.
Ethics Declaration
This article does not involve any human or animal subjects, and therefore does not require ethics approval.
Acknowledgements
We would like to express our gratitude to the patients, their families, and all those who have contributed to this study.
Conflicts of Interest
The authors report no conflicts of interest in this work.
About this article
Cite this article
Premanand Ponoth, James Kariuki, Antony Gikonyo, et al. Left Coronary Artery Fistula Masquerading as Coronary Insufficiency: A Rare Surgical Scenario. Indian J Cardiovasc Med Surg. 2026; 12(1): 21–25.
Licence:
Attribution-Non-commercial 4.0 International (CC BY-NC 4.0)This license enables reusers to distribute, remix, adapt, and build upon the material in any medium or format for noncommercial purposes only, and only so long as attribution is given to the creator.
| Received | Accepted | Published |
|---|---|---|
| February 28, 2026 | March 29, 2026 | April 30, 2026 |
DOI: 10.21088/jcms.2454.7123.12126.3
Keywords
Coronary artery fistulaCoronary EctasiaMyocardial ischemiaSurgical Ligation of EctasiaSearch for Similar Articles
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Timeline
| Received | February 28, 2026 |
| Accepted | March 29, 2026 |
| Published | April 30, 2026 |
licence
Attribution-Non-commercial 4.0 International (CC BY-NC 4.0)
This license enables reusers to distribute, remix, adapt, and build upon the material in any medium or format for noncommercial purposes only, and only so long as attribution is given to the creator.
