biostudies-literatureUnknown30(26)Panichella G<h4>Background</h4>Single coronary artery is a rare congenital anomaly. Its coexistence with coronary artery fistula is exceedingly uncommon.<h4>Case summary</h4>A 61-year-old woman with no cardiovascular risk factors underwent her first cardiological evaluation after incidental detection of atrial fibrillation. Imaging revealed a markedly dilated single coronary artery originating from the left coronary sinus, with a large fistula to the pulmonary artery trunk. Despite atrial enlargement and moderate mitral and tricuspid regurgitation, the patient was asymptomatic with preserved ventricular function. A conservative management strategy with close follow-up was adopted after multidisciplinary discussion.<h4>Discussion</h4>Management of rare coronary anomalies should be individualized. While surgery is recommended in symptomatic patients or those with evidence of ischemia, asymptomatic individuals may be managed conservatively; however, signs of adverse cardiac remodeling should prompt early reconsideration of intervention.<h4>Take-home message</h4>Conservative follow-up may be appropriate in asymptomatic patients with complex coronary anomalies, but progressive structural changes warrant timely reassessment of surgical options.JACC. Case reports104875https://www.ebi.ac.uk/biostudies/studies/S-EPMC12426679biostudies-literatureA Rare Case of Single Coronary Artery With Pulmonary Artery Fistula.PMC12426679Panichella GSpaziani GOlivotto IFavilli SPadeletti MfalseA Rare Case of Single Coronary Artery With Pulmonary Artery Fistula.<h4>Background</h4>Single coronary artery is a rare congenital anomaly. Its coexistence with coronary artery fistula is exceedingly uncommon.<h4>Case summary</h4>A 61-year-old woman with no cardiovascular risk factors underwent her first cardiological evaluation after incidental detection of atrial fibrillation. Imaging revealed a markedly dilated single coronary artery originating from the left coronary sinus, with a large fistula to the pulmonary artery trunk. Despite atrial enlargement and moderate mitral and tricuspid regurgitation, the patient was asymptomatic with preserved ventricular function. A conservative management strategy with close follow-up was adopted after multidisciplinary discussion.<h4>Discussion</h4>Management of rare coronary anomalies should be individualized. While surgery is recommended in symptomatic patients or those with evidence of ischemia, asymptomatic individuals may be managed conservatively; however, signs of adverse cardiac remodeling should prompt early reconsideration of intervention.<h4>Take-home message</h4>Conservative follow-up may be appropriate in asymptomatic patients with complex coronary anomalies, but progressive structural changes warrant timely reassessment of surgical options.2025-01-01T00:00:00Z2025 Sep2026-04-08T19:52:25.038Z2026-04-08T14:35:40.183ZS-EPMC124266794091284010.1016/j.jaccas.2025.104875