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