Congenital Aortopulmonary Artery Fistulas Combined With Bilateral Coronary Artery Fistulas

We describe an extremely rare case of "congenital aortopulmonary artery fistulas" combined with bilateral coronary artery fistulas associated with clinically significant left-to-right shunt. A multi-detector row computed tomographic scan revealed that tortuous anomalous vessels arising from the aortic arch, left anterior descending coronary artery, diagonal branch, and right coronary artery were connected to the main pulmonary trunk. After surgical intervention, the systemic-to-pulmonary flow ratio nearly normalized from 2.02 to 1.05. We describe the case and speculate as to the embryological pathogenesis of these unique fistulas. (Ann Thorac Surg 2011;92:1524-6) (C) 2011 by The Society of Thoracic Surgeons