Rare case of coronary to pulmonary vein fistula with coronar
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Coronary artery anomalies are found in 1% of coronary angiograms. Some of these anomalies are clinically insignificant but, many others are associated with serious morbidity and potential mortality. Coronary artery anomalies can be detected by a variety of means including echocardiography, coronary artery angiography and multidetector-row computed tomography.
The following case report describes an elderly patient presenting with angina, whose coronary angiography and cardiac computed tomography (CT) revealed an abnormal communication between the left anterior descending (LAD) and the left superior pulmonary vein.

A 67-year-old man presented to the office with exertional chest pain of six weeks. He had a past medical history significant for hypercholesterolemia and gastro esophageal reflux disease. He quit smoking 30 years ago. A thallium stress test revealed a moderate sized, completely reversible, anterior and anterolateral wall defect suggestive of LAD territory ischemia. Coronary angiography was performed, which failed to reveal any obstructive disease in the LAD as well any other coronary vessel. However, in the distal segment of the LAD there was a small aneurysmal dilatation and a communication with an extracardiac vessel that was well opacified with antegrade injection of contrast. We concluded that it was likely to be a fistula between the LAD and a segment of the left pulmonary artery system.....

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