Cardiovascular flashlight. Coronary fistulas are not always bad: coronary artery to coronary artery fistula as a very unusual collateral pathway.

摘要

A 57-year-old man presented to the emergency room with light-headedness. There was no prior history of chest pain but his electrocardiography showed Q-waves, ST-segment elevation, and negative T-waves in V1-3. Echocardiography showed apical dyskinesia and an ejection fraction of 40-45%. Coronary angiography showed that the right and the circumflex artery were normal. The left anterior descending artery (LAD) was occluded just after the origin of first diagonal and septal branches. The apical part of the LAD was filling with Rentrop grade 2 collaterals from the right coronary. There was a fistula originating from the proximal LAD that, after a meandering superior, anterior, and inferior course, drain into the junction of the mid-LAD with second septal branch (Panels A and 8). It drew a star-like picture. The fistula served as a collateral circulation between the proximal and mid-LAD coronary artery.