Generalized Coronary Arterio-systemic (Left Ventricular) Fistula Case Report and Review of Literature

• Published in: Japanese Heart Journal Vol. 27; no. 4; pp. 533 - 544
• Main Authors: SHEIKHZADEH, Abdolhamid, STIERLE, Ulrich, LANGBEHN, Axel-Friedrich, THORAN, Peter, DIEDERICH, Karl-Werner
• Format: Journal Article
• Language: English
• Published: Tokyo International Heart Journal Association 1986; Japanese Heart Journal Association
• Subjects: Angina Pectoris - etiology; Angina Pectoris - physiopathology; Biological and medical sciences; Cardiology. Vascular system; Clinical assessment; Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava; Coronary artery-to-left ventricular fistula; Coronary Vessel Anomalies - complications; Coronary Vessel Anomalies - diagnosis; Coronary Vessel Anomalies - physiopathology; Electrocardiography; Exercise Test; Female; Heart; Heart Ventricles - abnormalities; Heart Ventricles - physiopathology; Humans; Medical sciences; Middle Aged; Myocardial ischemia; Human; Multiple; Congenital; Ischemia; Malformation; Coronary artery; Myocardium; Adult; Cardiovascular disease; Fistula; Coronary arteriography; Left ventricle
• ISSN: 0021-4868; 1348-673X
• DOI: 10.1536/ihj.27.533

A coronary artery-to-left ventricular fistula is a rare finding; to the best of our knowledge, a total of only 35 cases have been reported. Only 5 cases of a generalized arterio-systemic fistula with three vessel involvement have been reported in the literature. We describe another case involving all major coronary arteries. A review of the literature is presented and the data of the reported cases are analyzed. A 55 year old woman was examined because of recurrent chest pain which had persisted for 2 years. On physical examination, the only abnormal finding was a fourth heart sound. Exertional chest pain, a positive exercise stress test, and the results of a lactate extraction study suggested severe myocardial ischemia. Thallium myocardial scintigraphy showed no evidence of a perfusion defect. Cardiac catheterization revealed an irregular left ventricular endocardial pattern (Thebesian veins). Selective coronary angiography showed communicating fistulae of all three major coronary arteries with the left ventricular cavity. We assume that this vascular anomaly causes a coronary steal phenomenon and subsequent myocardial ischemia.