Introduction: A 72 years old male, without previous cardiology background, underwent an elective coronary angiography due to new onset of chest pain. Only mild non-obstructive atherosclerotic disease was found in the coronary arteries, with an unusual vessel arising from the left main coronary artery.
Methods: A cardiac CTA was performed demonstrating arteriovenous malformation (AVM) between the left main coronary artery and the main pulmonary artery, with aneurysmal dilatations of the proximal and distal parts of the fistula (Figure 1). Since the left to right shunt caused by the malformation was considered the reason for the patient`s symptoms, with an evidence of ischemia on SPECT, an angiographic intervention was planned.
Results: A combined team of interventional radiologists and cardiologists performed the procedure. A safety wire was placed in the LAD and a micro catheter was advanced into the distal part of the fistula. The distal aneurysm was embolized first using detachable coils, followed by insertion of micro-vascular plague into the middle part of the fistula. The proximal aneurysm was then packed using detachable coils, with closer of the AVM at the end of the procedure, without immediate complications. A follow-up SPECT one month after the procedure demonstrated normal myocardial perfusion.
Conclusions: Coronary AVM is a rare congenital disease which can produce symptoms of varying severity depending on the size of the malformation. Cardiac CTA can exclude obstructive coronary artery disease along with diagnosing the AVM. Once the anatomical details of the malformation are clear, an endovascular approach should be considered as an alternative to surgical procedures.
