Author + information
- Received June 3, 2008
- Revision received June 17, 2008
- Accepted June 24, 2008
- Published online February 10, 2009.
A 72-year-old woman presented with episodes of extreme exhaustion and fatigue occuring at rest. A continuous murmur (never before documented) was heard widely over the precordium. The effort electrocardiogram and echocardiogram were normal. At cardiac catheterization, a left-to-right shunt of 1.29:1 (Qp:Qs) was found. Coronary angiography (A and B) showed one fistula (F) arising in the right coronary artery (RCA) and ending in the pulmonary artery (PA), and a second fistula arising in the left anterior descending artery (LAD), also terminating in the pulmonary artery. Multislice computed tomographic angiography (C and D) showed the two fistulas (F1 and F2) entering the pulmonary artery separately. An attempt at coil embolization of the right coronary artery fistula failed and the patient was referred for surgical ligation of the fistulas. Post-operatively her symptoms have disappeared. Coronary artery fistulas are usually single and drain into one of the cardiac chambers, but drainage into the pulmonary artery is described (1). They are also often clinically silent and inconsequential. This case showed significant symptoms, probably on the basis of a coronary steal phenomenon.
- Received June 3, 2008.
- Revision received June 17, 2008.
- Accepted June 24, 2008.
- American College of Cardiology Foundation