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(Circulation. 1998;97:2091-2092.)
© 1998 American Heart Association, Inc.

Images in Cardiovascular Medicine

Fistula Between Left Main, Left Anterior Descending, and Pulmonary Arteries

Habib Abbas Dakik, MD; John Farmer, MD; ; Neal S. Kleiman, MD

From the Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Tex.

Correspondence to Neal S. Kleiman, MD, Section of Cardiology, The Methodist Hospital, 6535 Fannin St, F1090, Houston, TX 77030.

A 61-year-old man presented with a 2-month history of angina occurring at rest and on exertion. Coronary angiography showed a coronary fistula extending from the left main bifurcation to the distal left anterior descending artery (Fig 1; small arrows). A lateral view (Fig 2) shows contrast (small arrows) flushing from this fistula (large arrows) into the pulmonary artery. Fig 3 shows the pulmonary artery (small arrows) filling with contrast from the coronary fistula. An atherosclerotic plaque (large arrow) in the circumflex artery is also shown. No shunt could be detected by oximetric measurements, and the patient was managed medically for his coronary artery disease.

View larger version (111K): [in this window] [in a new window]   Figure 1.

View larger version (147K): [in this window] [in a new window]   Figure 2.

View larger version (123K): [in this window] [in a new window]   Figure 3.

The incidence of coronary artery fistulae in adult patients undergoing coronary angiography is reported to be 0.1% to 0.2%. To the best of our knowledge, this is the first case report of a coronary–coronary–pulmonary arterial fistula.

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke's Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1–267, Houston, TX 77030.

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This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Dakik, H. A. Articles by Kleiman, N. S. Search for Related Content PubMed PubMed Citation Articles by Dakik, H. A. Articles by Kleiman, N. S.