Abstract
Background: Arterial-to-arterial fistula between right posterolateral and left posterolateral coronary arteries is rare and available literature on it is scarce. Case Presentation: A 60-year-old male with type 2 diabetes mellitus and dyslipidemia presented with shortness of breath and chest tightness. Given his symptoms and poor functional status, myocardial perfusion imaging with regadenoson was performed. The myocardial perfusion imaging study was abnormal with evidence of ischemia in the inferoseptal myocardium. The patient proceeded to the cardiac catheterization lab for selective right and left coronary angiography. Contrast injection revealed non-obstructive coronaries; however, an arterial-to-arterial fistula between the right posterolateral (RPL) branch and left posterolateral (LPL) branch was present (Figure 1A and 1B). Further characterization of the fistula showed the presence of left-to-right and right-to-left filling, indicating a LPL to RPL coronary artery fistula (CAF). The patient was managed conservatively with aspirin, statin, and anti-anginal therapy. Conclusion: There remains a need for diagnostic and therapeutic guidelines to address CAF. Conservative treatment is an option for small CAFs and serves as a potential alternative to catheter-based and surgical closure.
Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
