Coronary Cameral Fistula in a Nigerian Adult with Chest Pain: A Rare Cause of Angina.

Abstract

Background: Coronary artery fistulas (CAFs) are rare defects in the coronary circulation with majority being asymptomatic. A coronary cameral fistula (CCF) is a type of CAFs with an abnormal communication with a cardiac chamber. It is often diagnosed while patients are being investigated for coronary artery disease and diagnosis requires high index of suspicion especially in patients with angina with no obstructive lesions. Symptomatic cases have variable clinical manifestation which depends on the size, origin and drainage site. Coronary computerised tomographic angiography (CCTA) has emerged as investigation of choice in investigating CAFs due to its high spatial and temporal resolution facilitating accurate assessment of the complex anatomy of CAFs. Treatment strategy for CCF is individualised with consideration for its symptomatology, haemodynamic significance and potential complication. Early diagnosis and treatment can improve outcomes in symptomatic patients.

Case report: We report the first case of coronary cameral fistula in Nigeria diagnosed by angiography and confirmed by coronary CTA. The patient was managed conservatively with antiplatelets and long-acting nitrates and monitored closely at outpatient follow up.