A case of coronary artery fistula with angina pectoris

A case of coronary artery fistula with myocardial ischemia is reported. A 57-year-old-man was admitted to our hospital complaining of anterior chest pain on exertion. Submaximal Treadmill exercise showed the depression of ST segment in leads II, III, aVF, V5 and V6. 75% stenosis of right coronary artery (segment 2) and congenital coronary artery fistula originating from both the right and left coronary arteries were demonstrated by the coronary arteriography. One abnormal artery was originated from proximal portion of the right coronary artery (segment 1) and entered the pulmonary artery trunk. Another one was originated from proximal portion of the left coronary artery and terminated in angiomatous plexus which then communicated with the pulmonary artery trunk. We speculate that myocardial ischemia resulted from decreased right coronary blood flow due to coronary steal and proximal organic stenosis of right coronary artery. Recently, the reviews of coronary artery fistula are increasing, but coronary artery fistula with myocardial ischemia is relatively rare. This case was followed with medical therapy, because antianginal agents were effective. Operative coronary ligation may be necessary, if he has angina or high output heart failure during follow-up.