Rare case of coronary to pulmonary vein fistula with coronary steal phenomenon

Abstract

Coronary artery fistulas are abnormal connections between coronary artery territories and cardiac chambers or major vessels, most of them are congenital. Patients with coronary artery fistula can be asymptomatic or present with different symptoms like angina. Cardiac computed tomography (CT) is one of the best modalities for diagnosis. We present an elderly patient that presented with angina symptoms, non invasive stress test was positive for ischemic heart disease, coronary angiogram could not reveal any obstructive lesions, but an abnormal branch of the left descending coronary artery (LAD), cardiac CT showed fistula that connect left anterior descending coronary artery to left superior pulmonary vein. Our case is extremely rare as most of the reported cases were fistulas between LAD and pulmonary artery, but in our case the fistula between LAD and left superior pulmonary vein. In addition, our patients’ symptoms resolved with anti-ischemic medical treatment without any surgical intervention.

Keywords: Coronary artery fistula; Coronary artery anomalies in adult; Coronary artery disease

Core tip: This report highlights the presence of an extremely rare coronary anomaly in adult, in the form of a fistula between left anterior descending coronary artery and left superior pulmonary vein with steal phenomenon causing angina that resolved by medical treatment.