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Related Experiment Video

Updated: Jul 2, 2026

Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery (ALCAPA)

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Multiple coronary to left ventricular fistulae.

Nalyaka Sambu¹, Rajan Sharma, Paul R Kalra

¹Department of Cardiology, Portsmouth Hospitals NHS Trust, Castle Lane East, Bournemouth, Dorset BH7 7DW, UK. sambunh@hotmail.com

European Journal of Echocardiography : the Journal of the Working Group on Echocardiography of the European Society of Cardiology

|August 30, 2008

Summary

Coronary artery fistula, a rare condition, caused inducible ischemia in a patient. Ivabradine provided symptomatic relief when other medications failed.

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Area of Science:

Cardiology
Cardiovascular Imaging
Interventional Cardiology

Background:

Coronary artery fistula is a rare congenital anomaly where coronary arteries connect directly to heart chambers.
This case presents a unique scenario of a 39-year-old female with chest pain attributed to coronary artery fistula.

Observation:

Cardiac catheterization revealed separate origins of the left anterior descending and circumflex arteries with fistulae into the left ventricle.
Stress echocardiography demonstrated inducible ischemia, characterized by left ventricular dilatation and hypokinesis, during dobutamine administration.
The patient experienced chest tightness, indicating a significant ischemic response.

Findings:

The coronary artery fistula likely caused a 'steal phenomenon,' diverting blood flow and increasing left ventricular end-diastolic pressure.
This mechanism resulted in inducible myocardial ischemia, mimicking symptoms of coronary artery disease.
Standard anti-ischemic medications (beta-blockers, calcium channel blockers) were ineffective or contraindicated.

Implications:

This case highlights the importance of considering rare anomalies like coronary artery fistula in patients with unexplained ischemic symptoms.
Stress echocardiography is a valuable tool for diagnosing inducible ischemia in complex cardiac conditions.
Ivabradine emerged as a viable therapeutic option for managing symptoms in this patient with medication intolerances.