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Case Report | Cardiology Science | Volume 15 Issue 6, June 2026 | Pages: 558 - 565 | India
An Unusual Combination of Giant LAD Aneurysm with Coronary AV Fistula Draining into the Main Pulmonary Artery and Common Coronary Ostium: A Case Report
Abstract: The coexistence of a giant left anterior descending artery (LAD) aneurysm, a coronary arteriovenous (AV) fistula draining into the main pulmonary artery (MPA), and a common coronary ostium supplying both the right coronary artery (RCA) and left main coronary artery (LMCA) from a single leftward-facing coronary sinus is an extraordinarily rare constellation of congenital coronary anomalies. We report a 54-year-old female presenting with a one-year history of palpitations and exertional dyspnoea (NYHA Class II), found to have a continuous murmur at the pulmonary area. Multimodality imaging including 2D echocardiography with transesophageal echocardiography (TEE) and CT coronary angiography (CTCA) identified a giant proximal LAD aneurysm measuring 6.3 ? 4.9 cm, a tortuous LAD-to-MPA fistulous connection with continuous left-to-right shunt, left atrial dilatation, preserved LV function (EF 60%), and a common RCA-LMCA ostium from the leftward-facing coronary sinus. The patient underwent successful surgical repair of the LAD aneurysm and fistula with concomitant coronary artery bypass grafting (CABG) using two saphenous vein grafts and has recovered well. This case highlights the diagnostic challenges of complex congenital coronary anomalies in adults, the indispensable role of CTCA in anatomical delineation, and the importance of multidisciplinary surgical planning.
Keywords: coronary artery aneurysm, coronary AV fistula, pulmonary artery fistula, single coronary ostium, CABG, congenital coronary anomaly
How to Cite?: Dr. Ramchandra Kumar, Dr. Faraz Ahmed, Prof. (Dr.) Hem Chandra Kalita, Prof. (Dr.) Mriganka Shekhar Chaliha, Asst. Prof. (Dr.) Shekhar Jyoti Gogoi, "An Unusual Combination of Giant LAD Aneurysm with Coronary AV Fistula Draining into the Main Pulmonary Artery and Common Coronary Ostium: A Case Report", Volume 15 Issue 6, June 2026, International Journal of Science and Research (IJSR), Pages: 558-565, https://www.ijsr.net/getabstract.php?paperid=SR26610220821, DOI: https://dx.dx.doi.org/10.21275/SR26610220821