Massive congenital coronary arteriovenous malformation presenting with exertional dyspnea and desaturation in an adult: A case report and review of the literature

A coronary arteriovenous fistula is a congenital or acquired coronary arter y anomaly in which blood is shunted into a cardiac chamber, great vessel or other structure, superceding the myocardial capillary network. The clinica l presentation may he heralded by the development of dyspnea, congestive he art failure, angina, endocarditis, dysrhythmias or myocardial infarction. T he authors describe a left to right coronary artery to coronary sinus shunt that produced an elevation in right atrial pressure during exercise and th ereby opened a patent foramen ovale and manifested as exercise-induced desa turation. Although noninvasive imaging may facilitate the diagnosis and ide ntification of the origin and insertion of coronary arteriovenous fistulae, cardiac catheterization is necessary for the precise delineation of corona ry anatomy, and to show the presence of concomitant atherosclerosis and str uctural anomalies. Possible therapeutic options in the management of corona ry arteriovenous malformations include transcatheter embolization, surgical correction or expectant management.