Faculty Bibliography

Coronary artery fistulas (CAFs) are abnormal communication between coronary arteries and the pulmonary trunk or with adjacent heart structures. Coronary pulmonary artery fistulas (CPAFs) can be congenital or acquired. Mostly, CAFs are found as incidental findings on angiographic evaluation. The management of CPAFs varies from case to case depending on size, anatomical location, patient's clinical presentation, and presence of coronary steal phenomenon. We present two cases of CPAFs; one of them had coronary steal phenomena at a young age with no past medical history of coronary artery disease, and the patient underwent transcatheter coil embolization to close the fistula. In other cases, a fistulous connection between the left anterior descending (LAD) and the pulmonary trunk was found incidentally on computed tomography (CT) of the heart and based on a small-sized fistula and symptomatic improvement, the patient was discharged with conservative management. CPAFs are rare cardiac anomalies but can give rise to severe hemodynamic complications, so this should be a part of the initial differential diagnosis if the patient does not have significant coronary artery disease. Percutaneous closure or surgical correction is indicated if the patients are symptomatic or have secondary complications.

Coronavirus disease 2019 (COVID-19) mRNA vaccine-related cases of pericarditis and myocarditis have been reported infrequently. Most of the patients usually present within a week of the vaccine, and on average, most of the cases were reported after the second dose of vaccine within two to four days. Chest pain was the most common presentation, and fever and shortness of breath were the other commonly reported symptoms. The patients can have positive cardiac markers and electrocardiogram (EKG) changes, and the cases can be mistaken for cardiac emergencies. We present a 17-year-old male patient with sudden onset substernal chest pain for two days who got the third dose of the Pfizer-BioNTech mRNA vaccine within 24 hours prior. EKG was remarkable for diffuse ST elevations, and troponins were elevated. Later, the cardiac magnetic resonance imaging confirmed the findings of myopericarditis. The patient was treated with colchicine and non-steroidal anti-inflammatory drugs (NSAIDs), completely recovered, and is doing fine to date. This case hights that post-vaccine myocarditis can be mistaken and early diagnosis and management can prevent unnecessary interventions.