{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T00:25:11Z","timestamp":1759883111278,"version":"build-2065373602"},"reference-count":12,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,1,2]],"date-time":"2025-01-02T00:00:00Z","timestamp":1735776000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Coronary artery fistulas (CAFs) are rare congenital anomalies, presenting in 0.05\u20130.9% of cases, characterized by an aberrant connection between a coronary artery and a cardiac chamber or great vessel. Clinical manifestations can include heart failure, myocardial ischemia due to coronary steal, arrhythmias, or infective endocarditis. We report a case of a 39-year-old man initially evaluated in 2016 for peripheral edema and suspected right ventricular (RV) abnormality. Earlier assessments indicated a left anterior descending (LAD) coronary artery\u2013RV fistula, but initial catheterization was nondiagnostic. Transthoracic echocardiography (TTE) revealed a dilated left coronary artery (LCA) and an RV apex aneurysm, confirmed by CT and coronary angiography, showing a 14 mm LAD fistula with large aneurysmal sacs (45.6 \u00d7 37.3 mm). Cardiac MRI demonstrated a tortuous LAD fistula draining into RV aneurysmal sacs with preserved biventricular function. Surgical intervention was recommended, but the patient declined and was lost to follow-up until 2022, being asymptomatic. Re-evaluation showed progression in aneurysm size (47 \u00d7 45 mm and 16 \u00d7 18 mm) without ventricular functional change. Follow-up TTE in 2023 indicated stable findings. This case emphasizes the necessity of multimodal imaging (TTE, CT, MRI, angiography) for CAF diagnosis and management planning. Given the variability in CAF presentation and outcomes, individualized management\u2014including surgical, percutaneous, or conservative strategies\u2014is crucial. Persistent follow-up is essential for monitoring potential complications and guiding treatment, even in asymptomatic patients refusing intervention.<\/jats:p>","DOI":"10.3390\/medicina61010056","type":"journal-article","created":{"date-parts":[[2025,1,2]],"date-time":"2025-01-02T10:32:26Z","timestamp":1735813946000},"page":"56","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Left Coronary Artery\u2014Right Ventricle Fistula Case Report: Optimal Treatment Decision"],"prefix":"10.3390","volume":"61","author":[{"given":"Stefan","family":"Veljkovi\u0107","sequence":"first","affiliation":[{"name":"Cardiovascular Institute \u201cDedinje\u201d, 111040 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana","family":"Peruni\u010di\u0107","sequence":"additional","affiliation":[{"name":"Cardiovascular Institute \u201cDedinje\u201d, 111040 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5623-7678","authenticated-orcid":false,"given":"Jovana","family":"Lak\u010devi\u0107","sequence":"additional","affiliation":[{"name":"Cardiovascular Institute \u201cDedinje\u201d, 111040 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2865-0446","authenticated-orcid":false,"given":"Armin","family":"\u0160ljivo","sequence":"additional","affiliation":[{"name":"Department of Cardiosurgery, Clinical Center of University of Sarajevo, 71000 Sarajevo, Bosnia and Herzegovina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dragana","family":"Radoi\u010di\u0107","sequence":"additional","affiliation":[{"name":"Cardiovascular Institute \u201cDedinje\u201d, 111040 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mihajlo","family":"Farki\u0107","sequence":"additional","affiliation":[{"name":"Cardiovascular Institute \u201cDedinje\u201d, 111040 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1358-2359","authenticated-orcid":false,"given":"Darko","family":"Boljevi\u0107","sequence":"additional","affiliation":[{"name":"Cardiovascular Institute \u201cDedinje\u201d, 111040 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8852-654X","authenticated-orcid":false,"given":"Jelena","family":"Kljajevi\u0107","sequence":"additional","affiliation":[{"name":"Cardiovascular Institute \u201cDedinje\u201d, 111040 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Milovan","family":"Boji\u0107","sequence":"additional","affiliation":[{"name":"Cardiovascular Institute \u201cDedinje\u201d, 111040 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2724-2854","authenticated-orcid":false,"given":"Aleksandra","family":"Nikoli\u0107","sequence":"additional","affiliation":[{"name":"Cardiovascular Institute \u201cDedinje\u201d, 111040 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"W237","DOI":"10.2214\/AJR.13.11613","article-title":"Prevalence and types of coronary artery fistulas detected with coronary CT angiography","volume":"203","author":"Lim","year":"2014","journal-title":"Am. J. Roentgenol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e003062","DOI":"10.1161\/CIRCINTERVENTIONS.115.003062","article-title":"Coronary artery fistulae","volume":"8","author":"Reddy","year":"2015","journal-title":"Circ. Cardiovasc. Interv."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1055\/s-0033-1349162","article-title":"Coronary arteriovenous fistulae: A review","volume":"23","author":"Pericleous","year":"2014","journal-title":"Int. J. Angiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"4200","DOI":"10.1093\/eurheartj\/ehaa614","article-title":"Recommendations for advance care planning in adults with congenital heart disease: A position paper from the ESC Working Group of Adult Congenital Heart Disease, the Association of Cardiovascular Nursing and Allied Professions (ACNAP), the European Association for Palliative Care (EAPC), and the International Society for Adult Congenital Heart Disease (ISACHD)","volume":"41","author":"Schwerzmann","year":"2020","journal-title":"Eur. Heart J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1093\/eurheartj\/ehaa554","article-title":"2020 ESC Guidelines for the management of adult congenital heart disease: The Task Force for the management of adult congenital heart disease of the European Society of Cardiology (ESC). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Adult Congenital Heart Disease (ISACHD)","volume":"42","author":"Baumgartner","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_6","first-page":"ytab15","article-title":"Percutaneous management strategies for STEMI with coexisting aneurysmal coronary- to-pulmonary artery fistula: A case report","volume":"5","author":"Frampton","year":"2021","journal-title":"Eur. Heart J.-Case Rep."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"ytaa581","DOI":"10.1093\/ehjcr\/ytaa581","article-title":"Right coronary artery\u2013left ventricular fistula with giant right coronary artery of diffuse ectasia: A case report","volume":"5","author":"Zhang","year":"2021","journal-title":"Eur. Heart J.-Case Rep."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1148\/rg.2018170158","article-title":"Coronary Artery Fistulas: Pathophysiology, Imaging Findings, and Management","volume":"38","author":"Yun","year":"2018","journal-title":"RadioGraphics"},{"key":"ref_9","first-page":"e24824","article-title":"Coronary Arteriovenous Fistula Originating From the Left Main Coronary Artery","volume":"14","author":"Kumar","year":"2022","journal-title":"Cureus"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1012","DOI":"10.1536\/ihj.16-627","article-title":"Surgical Treatment of Coronary to Pulmonary Artery Fistulas in Adults","volume":"58","author":"Lee","year":"2017","journal-title":"Int. Heart J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1002\/ccd.21125","article-title":"Coronary artery fistulas: How to manage them","volume":"70","author":"Latson","year":"2007","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e25","DOI":"10.15420\/icr.2022.34","article-title":"Coronary Artery Fistula: A Dignostic Dilemma","volume":"18","author":"Kumar","year":"2023","journal-title":"Interv. Cardiol."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/1\/56\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T15:23:25Z","timestamp":1759850605000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/1\/56"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,2]]},"references-count":12,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1]]}},"alternative-id":["medicina61010056"],"URL":"https:\/\/doi.org\/10.3390\/medicina61010056","relation":{},"ISSN":["1648-9144"],"issn-type":[{"type":"electronic","value":"1648-9144"}],"subject":[],"published":{"date-parts":[[2025,1,2]]}}}