The role of the fractional flow reserve in the coronary steal phenomenon evaluation caused by the coronary-pulmonary fistulas: case report and review of the literature

The role of the fractional flow reserve in the coronary steal phenomenon evaluation caused by the coronary-pulmonary fistulas: case report and review of the literature

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Abstract Background Congenital coronary-pulmonary fistulas (CPFs) are commonly unilateral; however, bilateral and multilateral fistulas are relatively rare.The steal phenomenon aroused from bilateral or multilateral CPFs, and was uncertain and seldom reported.We possess a new tool to assess the hemodynamic significance of coronary artery fistulas.This study aimed to describe the clinical presentation, diagnostic modalities, and management of the coincidentally detected congenital bilateral CPFs.Case presentation A case of a Humidifier 52 year-old female with 10 years history of typical palpitations and chest tightness was presented.

The selective coronary arteriography showed a right dominant coronary circulation without significant stenosis; however, with anomalous vessels originating from the proximal right and left anterior descending coronary Bar Cabinet arteries, draining into the pulmonary artery through a plexus of small vessels.We introduced the fractional flow reserve (FFR) to evaluate the hemodynamic significance of CPFs.The patient was successfully treated with coil embolization.Conclusions We presented the case of a female with typical palpitations and chest tightness due to the steal phenomenon that aroused from bilateral CPFs.The fistulas were safely and successfully closed by coil embolization.

We showed a new tool for the sophisticated evaluation of the hemodynamic significance of CPFs using FFR measurement and temporary occlusion of the fistula with a standard balloon.FFR could be a promising means for the treatment of decision making of the CPFs.