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[Coronary-left ventricular fistulae].

F Wolff, P Dumeny, C Zimmermann

    Archives Des Maladies Du Coeur Et Des Vaisseaux
    |November 1, 1981
    PubMed
    Summary
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    This case report details rare coronary-left ventricular fistulae diagnosed via angiography. The condition caused unstable angina due to a coronary steal syndrome, potentially treatable with surgery in select cases.

    Area of Science:

    • Cardiology
    • Vascular Surgery
    • Diagnostic Imaging

    Background:

    • Coronary artery fistulae are rare abnormal connections between coronary arteries and heart chambers.
    • Unstable angina can be a symptom of complex coronary artery anomalies.
    • Early and accurate diagnosis is crucial for appropriate patient management.

    Observation:

    • A 58-year-old man presented with new-onset unstable angina without myocardial infarction.
    • Coronary angiography revealed multiple fistulous communications between septal arteries, left diagonal branches, the right coronary artery, and the left ventricle apex.
    • Ascending aortography confirmed the diagnosis of coronary-left ventricular fistulae.

    Findings:

    • The coronary circulation showed dilatation and rapid emptying, indicative of increased flow from the shunt.

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  • No coronary artery stenosis or ectasia was observed.
  • The case highlights the rarity of fistulae involving both major coronary arteries and the left ventricle.

    • Implications:

    • Coronary-left ventricular fistulae can cause angina through a coronary steal phenomenon.
    • Angiography is the gold standard for diagnosing these fistulae.
    • Surgical intervention may be considered for cases with high flow and favorable anatomy.