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Bilateral coronary artery - pulmonary artery fistula with recurrent ventricular tachycardia: Case report

Stojšić-Milosavljević Anastazija (Faculty of Medicine, Novi Sad + Institute for Cardiovascular Diseases of Vojvodina, Sremska Kamenica)
Bikicki Miroslav (Faculty of Medicine, Novi Sad + Institute for Cardiovascular Diseases of Vojvodina, Sremska Kamenica)
Ivanović Vladimir (Faculty of Medicine, Novi Sad + Institute for Cardiovascular Diseases of Vojvodina, Sremska Kamenica)
Šobot Nikola (Clinical Center, Banja Luka, Republic of Srpska, Bosnia and Herzegovina)
Popin Momčilov Tijana (Faculty of Medicine, Novi Sad + Institute for Cardiovascular Diseases of Vojvodina, Sremska Kamenica)
Kovačević Dragan (Faculty of Medicine, Novi Sad + Institute for Cardiovascular Diseases of Vojvodina, Sremska Kamenica)

Introduction. Bilateral coronary artery fistulae to pulmonary artery with ventricular tachycardia have not yet been described in the literature. Case Outline. A case of a 23-year-old male patient who was treated at our clinic for recurrent ventricular tachycardia is presented. The patient was born with six fingers on his left hand, which was surgically corrected in his early childhood. Perfusion scintigraphy demonstrated reversible ischemia at the irrigation zone of the right coronary artery. The coronary angiography revealed two coronary to pulmonary artery fistulae. The right coronary artery fistula drained through a tubular vessel formation into the pulmonary artery, but the left anterior descendent fistula drained via multiple thin tortuous vessels into the pulmonary artery. The right coronary artery fistula was ligated surgically. The control scintigraphy registered no perfusion defect subsequently, but during the procedure ventricular tachycardia occurred. An electrophysiology study followed, but ventricular tachycardia could not be provoked. Two months later ventricular tachycardia occurred again. Two subsequent electrophysiology studies showed no ventricular tachycardia. The patient was treated with an implantable cardioverter defibrillator. Ventricular tachycardia was terminated four times during the first year follow-up. Conclusion. The mechanism of the ventricular tachycardia was unclear. The electrophysiology study was not sufficiently reliable in the patient with recurrent ventricular tachycardia and bilateral coronary artery to pulmonary artery fistulae. The therapy of choice and the prevention of sudden death in this case was an implantable cardioverter defibrillator.

Keywords: ventricular tachycardia, bilateral coronary artery to pulmonary artery fistulae, electrophysiology study, implantable cardioverter defibrillator