AUTHOR=Zhou Ting , Liu Chaobing , Zhang Songlin 

TITLE=Case report: Conquer a complex variant: Coronary-pulmonary artery fistulas, atrial septal defect and bicuspid pulmonary valve, under beating heart surgery

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.915874

DOI=10.3389/fcvm.2022.915874

ISSN=2297-055X

ABSTRACT=Coronary artery to pulmonary artery fistula(CPAF) is a congenital or acquired abnormal channel between arteries, with a left- to- right cardiac shunting, which may lead to myocardial ischemia, arrhythmia, thrombotic complications and  heart failure. CPAF is usually detected by coronary angiography, and  few reports have used beating heart surgery as detection method. A 39–year-old male diagnosed with  atrial septal defect (ASD), bicuspid pulmonary valve, and  moderate  tricuspid regurgitation, and he is totally asymptomatic. In preoperative evaluation,  significant CPAF  was suspected by echocardiography. The patient refused to conduct coronary angiography due to allergic history. Therefore, the cardiac team designed and deployed  the use of  on pump beating heart surgery to detect and repair these disorders, and suggested that OPBHS as myocardial protection strategy for patient at low surgical risk.  The rare and complex cardiovascular case that CPAFs  from two branches of the left anterior descending coronary artery to the main pulmonary artery  with ASD ,bicuspid pulmonary valve ,and  moderate  tricuspid regurgitation has not yet been reported in the  literature, and  its embryological hypothesis has been further analyzed.