Left anterior descending coronary artery–left ventricular fistula presenting as unstable angina and syncope

Abstract

Coronary artery fistulae are rare direct communications between a coronary artery and a cardiac chamber, the coronary sinus, the superior vena cava, or the pulmonary artery [1,2]. They may be congenital, or acquired, associated with various disorders, iatrogenic, traumatic, or spontaneous [1–3]. In most cases patients are asymptomatic and the fistulae are discovered during cardiac catheterization for congenital heart anomalies or coronary artery disease [1]. Rarely, they are the cause of heart failure, spontaneous intrapericardial rupture and tamponade, or myocardial ischemia attributed to a coronary “steal” phenomenon [2,4]. The management of coronary artery fistulae depends on associated symptoms, the magnitude of the left-to-right shunt, and the presence versus absence of other cardiac abnormalities [1,4,5]. In asymptomatic adult patients, the management remains controversial [1]. Symptomatic patients can be treated by transcatheter [2,5] or surgical techniques [1,2,4], while in some cases the fistula closes spontaneously [4,6].