Abstract
We report the case of a 70‐year‐old man with recent myocardial infarction who was admitted for further evaluation of his effort angina. Cardiac catheterization and selective coronary angiography excluded significant coronary atherosclerotic disease of the coronary arteries. Double coronary‐to‐pulmonary artery fistulas, one originating from the proximal right, the other from the left anterior descending coronary arteries, and draining into the right and left branch of the pulmonary artery, respectively, were observed. A left‐to‐right shunt was visualized at angiography. The patient was successfully treated with percutaneous alcohol and coil embolization of both coronary artery fistulas with total resolution of clinical symptoms. At 6‐month follow‐up a coronary angiography confirmed complete disappearance of the fistulas. We conclude that a “coronary steal” phenomenon caused by the fistulas induced myocardial ischemia in this patient and that percutaneous transcatheter exclusion with chemical and mechanical devices is a safe. effective, and reasonable alternative to traditional cardiac surgery.
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