Multiple coronary fistulae to left ventricle, with acute myocardial infarction

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Radiology

Background:

• Coronary artery fistulae are rare congenital or acquired abnormalities.
• Myocardial infarction (MI) is typically caused by atherosclerosis, but other causes exist.

Observation:

• A patient presented with myocardial infarction.
• Coronary angiography revealed multiple coronary artery fistulae.
• These fistulae originated from the left anterior descending, right coronary, and circumflex arteries.
• The fistulae drained directly into the left ventricle.

Findings:

• A myocardial perfusion scan demonstrated a fixed perfusion defect, indicating irreversible damage to the heart muscle.
• The anatomical findings suggest the fistulae were the cause of the MI.

Implications:

• This case highlights coronary artery fistulae as a potential, albeit rare, cause of myocardial infarction.
• Accurate diagnosis via angiography is crucial for appropriate management.
• Understanding these rare vascular anomalies is important for cardiovascular specialists.