MEDICAL AREA   

Medicina dello Sport 2010 December;63(4):531-7

Copyright © 2011 EDIZIONI MINERVA MEDICA

language: English, Italian

An unusual case of coronary-pulmonary fistula that makes it impossible to certify a runner’s fitness

Marzullo M. ¹, Messina M. ¹, Manganiello M. ¹, Martello R. ¹, Palumbo G. ²

¹ Department of Sports Medicine “Federico II” University, Naples, Italy 2 Department of Sports Medicine “D’Annunzio” University, Chieti, Italy

Aim. We report an unusual case of coronary anomaly characterized by a coronary-pulmonary fistula determining stenosis of the anterior descending branch in a sportsman, due to flow steal.
Methods. Thanks to second level cardiological examinations carried out on a forty-year-old athlete, we found ECG graphic anomalies during a maximal treadmill exercise test (TET) to certify his fitness for competitive sport (running). A coronarography was performed which revealed a fistula that shifted the flow from the anterior descending branch to the right pulmonary artery and a long stenosis, adjacent to the ostium of the fistula, which reduced the flow in the distal branch of the coronary artery. However, it did not present the typical features of atherosclerotic plaque but of coronary artery steal, such as coronary hypoplasia. After performing myocardial revascularization, it was decided to leave the fistula active.
Results. A coronarographic check after one year showed that the coronary-pulmonary fistula had disappeared. The arterial graft was patent and functioning well and the ventricular kinesis was normal. The athlete no longer reported ischemic symptoms and had returned to the lifestyle of a person not suffering from atherosclerosis. He was considered fit to run.
Coronary-pulmonary fistula is a communication between the left anterior descendent (LAD) of the left coronary artery and the right pulmonary artery. Patients are generally asymptomatic. In this case, the second level tests, such as the maximal treadmill exercise test (TET), indicated the need to execute a coronarography, which highlighted the coronary anomaly. In our case the minor hemodynamic importance of the fistula oriented us to myocardial revascularization.
Conclusion. This clinical case demonstrates that an instrumental non-invasive and low-cost procedure can reveal an insidious disease that poses a high risk for the life of an athlete considered to be in good health. Only these tests, therefore, can effectively reveal anomalies that could be catastrophic.