Myocardial Ischemia Secondary to a Large Coronary-Pulmonary Fistula

Abstract

Coronary-pulmonary fistulas are rare. The majority of these fistulas arise from the left anterior descending or the right coronary arteries; the circumflex coronary artery is rarely involved. The majority of patients are asymptomatic, but heart failure, angina, myocardial infarction, endo carditis, and dyspnea have rarely been reported. The management is controversial and recom mendations are based on anecdotal cases or very small retrospective series. A case of a 62- year-old female is reported who presented with chest pain and was found to have myocardial ischemia on SPECT sestamibi. Cardiac catheterization revealed no obstructive coronary artery disease and a large coronary pulmonary fistula communicating from the left circumflex coronary artery to the left pulmonary artery.