Bilateral coronary artery fistula: a unique case!
A coronary artery fistula (CAF) involves a sizable communication between a coronary artery, bypassing the myocardial capillary bed and entering either a chamber of the heart (coronary-cameral fistula) or a great vessel. Bilateral coronary artery fistula, are a rare variant. Published in the Journal of the Association of Physicians of India, the authors describe a bilateral CAF with angina and significant coronary artery disease requiring percutaneous coronary intervention.

A 49 year old male patient presented with complaints of chest pain on and off for past 5 years which had worsened 7 hours prior to presentation. He was a smoker and had diabetes mellitus.

His physical examination was unremarkable with normal blood pressure. His ECG showed Q-waves in the inferior leads. 2D-echo showed normal size cardiac chambers with mild left ventricular hypertrophy and a left ventricular ejection fraction of 60%.

He was taken up for coronary angiogram subsequently and it revealed a critical stenotic lesion in mid RCA and D1. There was an AV fistula from the proximal LAD to the pulmonary artery and from conal branch of RCA to the pulmonary artery.

He was subsequently taken up for PTCA and an Everolimus-eluting stent 3.5 x 28 mm was deployed in mid RCA with no complications. For the D1 lesion he was managed medically. As patient became asymptomatic after PCI of RCA lesion no intervention was performed for CAF. He has been on regular follow up and has remained asymptomatic post-procedure.

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