Left Anterior Descending Coronary Artery Fistula to Main Pulmonary Artery with Triple Vessel Disease: A Report of Two Cases

This report described two cases of left anterior descending coronary artery (LAD) fistula to the main pulmonary artery (MPA) with concomitant triple vessel disease. The first case involved a 59-year-old male with severe mitral regurgitation (MR) and LAD fistulation to MPA, while the second case involved a 57-year-old male with trivial MR and tortuous LAD fistulation to MPA. Both patients underwent teflon pledget-reinforced direct suturing of the fistula origin and triple coronary artery bypass grafting, with the first patient also receiving mitral annuloplasty and valvuloplasty. Post-operative periods were uneventful, and both patients were discharged after 17 and 5 days, respectively. Short-term follow-up showed symptom improvement and no residual fistulation, suggesting that teflon pledget-reinforced direct suturing of coronary fistula origin was satisfactory in the short term. Further studies and follow-up were recommended.