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- Received September 30, 2009
- Accepted October 8, 2009
- Published online March 23, 2010.
A 46-year-old man without significant previous medical history was admitted to our hospital with chest pain. His electrocardiogram revealed an anterior myocardial infarction, and he was immediately taken to the catheterization laboratory for emergent angiography. Angiography showed total occlusion of the left anterior descending artery immediately distal to first diagonal branch. Additionally, a coronary fistula stemming from the proximal circumflex artery and draining to pulmonary artery was noted (A, Online Video 1). We decided to treat the left anterior descending artery lesion, and balloon angioplasty with stenting was performed. Surprisingly, after complete alleviation of the lesion, repeat angiograms showed that the fistula had vanished (B, Online Video 2). A coronary angiogram with computerized tomography obtained 1 week later showed a fistula without any contrast passage to the pulmonary artery (C). The coronary steal phenomenon is a known complication of coronarocameral fistulas (1). Previously, it was shown experimentally that reducing resistance to flow in the native artery may “steal” back the blood directed to a fistula (2). However, this is the first clinical case showing that reducing resistance to blood flow through native arteries may divert back the flow away from the fistula.
- Received September 30, 2009.
- Accepted October 8, 2009.
- American College of Cardiology Foundation