title: Coronary Fistula and Myocardial Ischemia: What is the Relationship?
abstract: Coronary artery fistula is a rare anomaly; large fistulae may result in myocardial ischemia from coronary steal. We present the case of a 73-year-old male who presented with exertional angina; imaging demonstrated severe coronary artery disease and a large coronary artery fistula. Ligation of the fistula resulted in severe right ventricular failure and cardiogenic shock. After reestablishing flow to the fistula, the patient recovered. We speculate that the ischemia-induced angiogenesis from the congenitally present fistula made what may have otherwise been an innocent fistula into an important nutritive supply, which remained important despite distal revascularization. To our knowledge, this is the first report describing the critical nutritive value of a coronary fistula.
authors: Ashish H
authors: AH
authors: Shah
authors: Robert J
authors: RJ
authors: Cusimano
authors: Toronto General Hospital, 585 University Avenue, Toronto, ON, M5G 2N2 Canada. maral.ouzounian@uhn.ca.
authors: Maral
authors: M
authors: Ouzounian
mesh_terms: D000368:Aged; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D003330:Coronary Vessel Anomalies / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology / Q000601:surgery; D008026:Ligation / Q000009:adverse effects / Q000379:methods; D008297:Male; D012086:Reoperation; D012770:Shock, Cardiogenic / Q000209:etiology / Q000601:surgery; D016896:Treatment Outcome; D016157:Vascular Fistula / Q000175:diagnosis / Q000503:physiopathology; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods; D018497:Ventricular Dysfunction, Right / Q000209:etiology / Q000601:surgery