Coronary Artery Fistula and Severe Coronary Artery Stenosis: A Case Report and an Insight for Potential Pathogenesis of Coronary Artery Atherosclerosis

Abstract

Coronary artery fistulae (CAF) are a rare anomaly characterized by abnormal connections between a coronary artery and a cardiac chamber or a great vessel, with most patients remaining asymptomatic. Despite being predisposed to severe complications like heart failure, patients with CAF infrequently experience severe stenosis in the coronary artery. This study delineates a case involving a 46-year-old male presenting with a fistula bridging the right coronary artery (RCA) and right atrium (RA), manifesting a pronounced 99% stenosis at the right extremity of the coronary artery proximal to the fistula. Concurrently, the individual exhibits six conventional risk factors: age over 40, male gender, hypertension, diabetes, smoking, and hypertriglyceridemia. Following pharmaceutical intervention, the patient was discharged and subjected to extended follow-up. This case highlights the dual processes of “accelerating damage” and “retarding renewal” in the progression of atherosclerosis. Factors such as shear stress, smoking, and hypertension are posited to expedite endothelial cell damage, while aging and diabetes may impede the renewal and repair of these cells. Together with the concept of secondary atherosclerotic plaque healing, this case prompts the introduction of a “Double Endothelial Healings” hypothesis, proposing a potential pathogenetic mechanism for coronary artery atherosclerosis.

Keywords:

• coronary artery fistulae
• atherosclerosis
• pathogenesis
• plaque healing
• endothelial injury

Consent

The authors confirm that written consent for submission and publication of this case report including image(s) and associated text has been obtained from Anyang People’s Hospital (Henan Province, China) and written consent has been obtained from the patient.

Acknowledgments

We thank Dr. Ming Liu (Heart Center, Anyang People Hospital, Anyang, Henan Province 455000) for his help in original data collection and writing assistance.

Disclosure

No conflict of interest is declared.

Additional information

Funding

This study was supported by the National Natural Science Foundation of China (grant 82171190), and Key scientific research projects of colleges and universities in Henan Province (22B310001).