Coronary fistulas represent communications that form between the coronary arteries and a heart chamber or a large vessel. The real incidence is not known as well as their real clinical impact. Typically congenital, they can also develop following surgery.
The treatment of fistulas remains complex: in the past surgical treatment was opted for, currently percutaneous closure is preferred although many hemodynamists prefer a conservative approach.
We describe the case of a man with stress-inducible ischaemia, probably due to the presence of a ventriculo-coronary fistula.
58-year-old Caucasian man arrives for coronary angiography following a positive ergometric test for signs and symptoms of reduced coronary reserve.
The patient had recently undergone a cardiac MRI that showed an hypertrophic cardiomyopathy with partial end systolic obliteration of the apex with areas of intramyocardial fibrosis in middlewall distribution.
Coronary angiography showed an epicardial coronary circulation free from angiographically significant lesions with evidence, however, of a ventriculo-coronary fistula (departing from the anterior interventricular artery).
Since other causes were excluded, the hypothesis was that the fistula could be the cause of stress-inducible myocardial ischemia, through a coronary steal mechanism.
