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- Received October 14, 2010
- Accepted October 21, 2010
- Published online August 23, 2011.
A 40-year-old man with known cystic fibrosis (CF) was referred to our institution for cardiac evaluation as part of pre-lung transplantation assessment. Left heart catheterization revealed multiple fistulas arising from all 3 coronary arteries with unclear draining paths (A, from left anterior descending artery [arrow 1] and left circumflex artery [arrow 2]; B, from right coronary artery [arrow 1] to a plexus of small intrathoracic vessels [arrow 2], Online Videos 1 and 2). Computed tomography coronary angiography was performed, showing the complex fistulas (C, arrows) originating from all 3 coronary arteries (C: L, R, C) with apparent drainage to bronchial arteries (D, arrowhead = right coronary artery, short arrow = fistula plexa, long arrow = bronchial artery).
Very few cases of single left or right coronary artery fistulas to bronchial arteries have been reported in the published data (1). However, the complexity of fistulas involving all 3 coronary arteries in this case seems to be unique. The finding of these fistulas is critically important in patients undergoing thoracic surgeries for appropriate surgical planning. Computed tomography coronary angiography can play an important role in evaluation of the extent and drainage paths of these fistulas.
- Received October 14, 2010.
- Accepted October 21, 2010.
- American College of Cardiology Foundation