Bilateral coronary-pulmonary artery fistulas associated with coronary artery stenosis

Coronary artery venous fistulas (CAVFs) are rare congenital anomalies often detected incidentally during routine coronary angiography. While asymptomatic CAVFs are usually managed conservatively due to their potential to regress or close spontaneously, symptomatic CAVFs require intervention. This report presents the case of a 67-year-old female patient with a history of hypertension, type 2 diabetes, and hypercholesterolemia, who presented with chest pain and exertional dyspnea. Routine angiography revealed bilateral CAVFs with fistulas originating from both the left and right coronary arteries, in addition to critical stenoses in the left anterior descending artery and the circumflex artery. The patient underwent CAVFs closure surgery combined with coronary artery bypass grafting (CABG). Postoperatively, all cardiac symptoms were completely resolved. This case highlights that CAVFs should also be considered as a rare cause of ischemic heart disease and demonstrates the effectiveness of surgical intervention in the treatment of symptomatic cases.