Voluminous fistula between the right coronary artery and a branch of the pulmonary artery causing myocardial ischemia.
A 76-year-old female patient was referred to our institution because of typical chest pain. A continuous murmur was audible at the lower sternal border. A transthoracic echocardiogram showed non-dilated right and left ventricles with mild left ventricular inferior wall hypokinesia and an exercise stress test was positive for myocardial ischemia. A coronary angiogram showed no signs of atherosclerotic coronary artery disease, but it revealed a voluminous fistula between the proximal segment of the right coronary artery and a branch of the pulmonary artery, which was percutaneously closed using 3 embolization coils. Such late presentation of a voluminous coronary fistula is extremely rare and, to the best of our knowledge, very few case reports like this have been published.
Cardiology Department, Coimbra Hospital and University Centre, Centro Hospitalar de Coimbra, Coimbra, Portugal. sergioncbarra@gmail.com
Sérgio
S
Barra
Luís
L
Seca
Leitão
L
Marques
D000368:Aged; D001159:Arterio-Arterial Fistula / Q000150:complications* / Q000000981:diagnostic imaging* / Q000628:therapy; D002637:Chest Pain / Q000209:etiology; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D004452:Echocardiography; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D017202:Myocardial Ischemia / Q000209:etiology*; D011651:Pulmonary Artery / Q000000981:diagnostic imaging*; D016896:Treatment Outcome