International Medical Case Reports Journal (Mar 2024)
Coronary Artery Fistula and Severe Coronary Artery Stenosis: A Case Report and an Insight for Potential Pathogenesis of Coronary Artery Atherosclerosis
Abstract
Jinchun Liu,1 Zhijun Yu,2,3 Guohua Wang2 1Department of Medicine, Henan Vocational College of Nursing, Anyang, Henan Province, 455000, People’s Republic of China; 2Department of Neurophysiology and Neuropharmacology, Institute of Special Environmental Medicine and Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu, 226019, People’s Republic of China; 3Department of Thoracic Surgery, Nantong Second People’s Hospital, Nantong, Jiangsu, 226001, People’s Republic of ChinaCorrespondence: Guohua Wang, Email [email protected]: 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
