Circumflex artery (LCx) (Figure 1G), obtuse marginal branches (OM) and right coronary artery (RCA) followed the usual course. The branch OM1 from LCx was visualized just behind the LM division (Figure 1H). RCA was dominant (Figure 1I). The coronary arteries showed compact, parietal, calcified atherosclerotic plaques that didn’t result in substantial stenosis. There had been quite a few tortuous branches of a coronary artery fistula of varying width around the main pulmonary artery (MPA) (Figure 1J). The connection of one branch with the fistula using the MPA was visualized (Figure 1K). Thus, the diagnosis as a coronary-pulmonary artery fistula (CPAF) was clarified. In CPAF vessel topography, a high-density structure was visualized (Figure 1L). This structure could be the material that has been employed to close the fistula throughout a preceding operation, presumably a vascular coil. Within the functional CCTA assessment, left N-(3-Azidopropyl)biotinamide Autophagy ventricular ejection fraction was 65 (Figure 1M). The pathological alterations that had been visualized within the CCTA (contrasted, several, smaller vessels on the coronary-pulmonary fistula) indicate the final diagnosis of recanalization in the coronary-pulmonary fistula, which was surgically closed within the previous). The patient was referred to a cardiac surgery clinic for additional therapy preparing.Diagnostics 2021, 11,Diagnostics 2021, 11, x FOR PEER Critique three of3 ofFigure 1. Recanalization of your coronary-pulmonary fistula in coronary artery computed tomography angiography: (A) Diagram from the course in the coronary arteries, which is common; and observed in our case. (B) Volume Rendering Technique (VRT). Developmental anomaly from the left coronary artery course. (C) Maximum intensity projection (MIP). Axial view. Developmental anomaly with the left coronary artery course. (D) Curved planar reformation (CPR). Left anterior descending artery (LAD). Muscle bridge is marked with an arrow. (E) Curved planar reformation (CPR). 1st diagonal branch (Dg1). (F) Curved planar reformation (CPR). 2nd diagonal branch (Dg2). (G) Curved planar reformation (CPR). Left circumflex artery (LCx). (H) Curved planar reformation (CPR). 1st obtuse marginal branch (OM1). (I) Curved planar reformation (CPR). Appropriate coronary artery (RCA). (J) Volume Rendering Method (VRT). Branches of a coronary artery fistula around key pulmonary artery (MPA). Branches on the coronary artery fistula are marked with arrows. (K) Maximum intensity projection (MIP). Axial view. Coronary artery fistula (CAF) connection with main pulmonary artery (MPA). Connection is marked with an arrow. (L) Maximum intensity projection (MIP). Axial view. Postoperative adjustments just after closure of the coronary fistula. High-density structure in coronary artery fistula is marked with an arrow. (M) Left ventricular functional assessment. Left ventricular ejection fraction (EF)-65 .Diagnostics 2021, 11,4 ofAuthor Contributions: Investigation, P.G. and R.P.; writing–original draft preparation, P.G., A.M. and P.P.; writing–review and editing, R.P.; visualization, P.G.; supervision, R.P. All authors have read and agreed to the published version on the manuscript. Funding: This investigation received no external funding. Institutional Review Board Statement: The manuscript contains a presentation in the description of diagnostic tests of a selected patient; the Sordarin In stock operate does not describe a healthcare experiment–the opinion of your bioethics committee was not needed. Informed Consent Statement: The patient gave his written consent to the e.