First Diagonal to Left Ventricle Fistula With LAD Collateral Flow: An Unusual Coronary Detour.
Recommended Citation
Stephan J, Uddin M, Woods E, Zughaib M. First Diagonal to Left Ventricle Fistula with Lad Collateral Flow: An Unusual Coronary Detour. JACC Case Rep. 2026;31(36):109518.
Document Type
Article
Publication Date
9-9-2026
Publication Title
JACC Case Rep
Abstract
BACKGROUND: Coronary artery fistulas are rare vascular anomalies connecting a coronary artery to a cardiac chamber or vessel. While typically associated with ischemia via coronary steal, they can paradoxically serve a protective role.
CASE SUMMARY: We present a 57-year-old Asian male with 2 weeks of effort angina who was found to have an elevated high-sensitivity troponin. Urgent coronary angiography revealed a 100% mid left anterior descending artery (LAD) occlusion with collateral flow supplied predominantly by a fistulizing first diagonal artery (D1) communicating with the left ventricle.
DISCUSSION: The D1 fistula branches provided critical left-to-left collateral perfusion to the occluded LAD territory, likely limiting ischemic burden and preserving ventricular function. The LAD was successfully recanalized with drug-eluting stent placement, and percutaneous transluminal coronary angioplasty of the D1 was performed.
TAKE-HOME MESSAGE: This case demonstrates that coronary artery fistulas are not inherently pathological and highlights the importance of individualized anatomical assessment when planning coronary interventions.
PubMed ID
42524777
Volume
31
Issue
36
First Page
109518
Last Page
109518
