Applying preoperative multidetector computed tomography to bilateral coronary artery fistulas

Coronary artery fistula arising from both the right coronary artery and the circumflex coronary artery is rare. A 28-year-old woman with non-insulin-dependent diabetes mellitus and end-stage renal disease who was on regular hemodialysis complained of recent progressive exertional dyspnea. Congestive heart failure was diagnosed during work-up for simultaneous kidney and pancreas transplantation. Bilateral coronary fistulas draining into the coronary sinus were found by coronary angiography and further characterized by multidetector computed tomography followed by 3D reconstruction preoperatively. The operation was performed smoothly without heart arrest.