[Left coronary artery-pulmonary artery fistula. Case report]

A case of a 45-year-old male with anterior descending branch of the left coronary artery fistula to the main pulmonary trunk is reported. The patient was admitted because of a retrosternal pain. ECG showed ST-elevation in leads V2-3. This was first episode of anginal symptoms. The authors suggest that the single episode of coronary pain may have been provoked by faintness (following alcohol consumption) in the mechanism of the steal syndrome or by coronary spasm. A fistula (on coronarography) was diagnosed (the coronary arteries showed no changes). The value of the shunt calculated via Flick's method was 1.1 l/min. Exercise test, 24-hour ECG recording as well as stress thallium scintigraphy did not reveal post-exertion ischemic changes. During a 17-month post hospitalization follow-up the patient reported no anginal symptoms. Because of the small shunt and asymptomatic follow-up no surgical treatment was recommended.