case_images: PMC10799663_01
case_images: Echocardiography results reveal shunt flow into the pulmonary artery. The shunt flow into the pulmonary artery showed a Qp/Qs of 1/2.1. Ao, aorta; LA, left atrium; PA, pulmonary artery; PV, pulmonary valve; RVOT, right ventricular outflow tract.
case_images: ytae006f1.jpg
case_images: PMC10799663_01_ytae006f1.jpg
case_images: ytae006-F1
case_images: Doppler ultrasonography revealed left atrial pressure elevation (E/e': 15.8), trivial tricuspid regurgitation, and a large shunt flow into the pulmonary artery (Figure 1). Target XXL s: 6 x 400 mm, 5 x 200 mm, and two Target XL  Softs: 4 x 120 mm) (Stryker Inc., Tokyo, Japan) (Figure 3, Supplementary material online, Video S1). The procedure improved Qp/Qs from 1/2.1 to 1/1.5.
case_images: Coronary computed tomography images and angiography of coronary-to-pulmonary artery fistulas. (A) Axial coronary computed tomography detected CPFs and a coronary aneurysm. (B) Axial coronary computed tomography detected an RCA-PA fistula and LAD-PA fistula. (C) Axial coronary computed tomography detected bridging vessels between the CPFs. (D) Coronary computed tomography detected CPFs from LAO 30  CRA 0  and LAO 90  CRA 0 . (E) Contrast was simultaneously injected from the coronary ostia of the RCA and LAD. The CPFs from the RCA and LAD flowed into the same point of the PA. The bridging vessel between the CPFs from the RCA and LAD was revealed by coronary angiography. Ao, aorta; CPF, coronary-to-pulmonary artery fistula; LAD, left anterior descending artery; RCA, right coronary artery; LM, left main coronary artery; LV, left ventricle; PA, pulmonary artery; RV, right ventricle.
case_images: ytae006f2.jpg
case_images: PMC10799663_01_ytae006f2.jpg
case_images: ytae006-F2
case_images: Furthermore, a small coronary artery aneurysm (10 x 12 mm) was observed in the ostium of the LAD (Figure 2). Two fistulas were embolized using detachable coils (two Target XXL s: 8 x 400 mm and four Target XL  Softs: 8 x 300 mm and 4 x 120 mm) (Figure 4, Supplementary material online, Video S2).
case_images: The coronary angiography results after the first procedure. (A) A strongly winding CPF flowed into the PA from the RCA. (B) The CPF arising from the RCA disappeared after the coil embolization. The bridging vessels between two CPFs from the RCA and LAD also disappeared. CPF, coronary-to-pulmonary artery fistula; LAD, left anterior descending artery; PA, pulmonary artery; RCA, right coronary artery.
case_images: ytae006f3.jpg
case_images: PMC10799663_01_ytae006f3.jpg
case_images: ytae006-F3
case_images: Target XXL s: 6 x 400 mm, 5 x 200 mm, and two Target XL  Softs: 4 x 120 mm) (Stryker Inc., Tokyo, Japan) (Figure 3, Supplementary material online, Video S1). The procedure improved Qp/Qs from 1/2.1 to 1/1.5.
case_images: The coronary angiography results after the second procedure. (A) The CPFs flowed into the PA from the LAD, and the aneurysm was on the proximal region of the LAD. (B) The two fistulas were embolized with coils. The CPFs arising from the LAD disappeared, and blood flow into the LAD increased. CPF, coronary-to-pulmonary artery fistula; LAD, left anterior descending artery; PA, pulmonary artery.
case_images: ytae006f4.jpg
case_images: PMC10799663_01_ytae006f4.jpg
case_images: ytae006-F4
case_images: Two fistulas were embolized using detachable coils (two Target XXL s: 8 x 400 mm and four Target XL  Softs: 8 x 300 mm and 4 x 120 mm) (Figure 4, Supplementary material online, Video S2).
case_images: The follow-up coronary angiography results, 6 months after the procedure. The coronary angiography results showed that the size of the aneurysm 6 months after the procedure (B) was almost the same as that before the procedure (A).
case_images: ytae006f5.jpg
case_images: PMC10799663_01_ytae006f5.jpg
case_images: ytae006-F5
case_images: Six months later, follow-up coronary angiography revealed a small shunt flow from both CPFs; however, the aneurysm size never changed angiographically (Figure 5).