CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 2, March 2012
AFRICA
e1
Case Report
Multiple coronary cameral fistulae: a rare anomaly and
cause of ischaemia
C SENGUL, H FOTBOLCU, K OZDEN, D DUMAN
Abstract
An 82-year-old hypertensive, diabetic woman was admitted
to our department for pre-operative cardiac evaluation. A
myocardial perfusion scan revealed apicoseptal and inferior
segment hypoperfusion. Coronary angiography exhibited
extensive multiple coronary cameral fistulae draining into
the left ventricle in a homogeneous and circular way.
Keywords:
coronary fistula, coronary anomaly, multiple,
ischaemia
Submitted 29/6/10, accepted 26/11/10
Cardiovasc J Afr
2012;
23
: e1–e2
DOI: 10.5830/CVJA-2010-097
Case report
An 82-year-old hypertensive, diabetic woman was admitted to
our department for pre-operative cardiac evaluation because of
a planned cholecystectomy operation. She had been suffering
from effort angina pectoris for the last three years. Due to lack of
exercise capacity, a myocardial perfusion scan with dipyridamole
was planned for prediction of pre-operative cardiac risk. This test
revealed apicoseptal and inferior segment hypoperfusion.
Coronary angiography was performed. The first injection in
spider view showed extensive multiple coronary fistulae with a
circular arrangement, draining into the left ventricle (Fig. 1). A
right anterior oblique view revealed that the fistulae originated
not only from the left anterior descending artery, but also from
the left circumflex artery. Their bi-coronary origination allowed
us to obtain a left ventriculograph, mimicking conventional left
ventriculography, using a pigtail catheter (Figs 2, 3). There was
no significant stenosis in the left and right coronary system.
Because of her documented ischaemia, the non-cardiac
elective surgery was postponed and metoprolol 50 mg/day was
prescribed. The patient was examined at follow up after three
months and she had no symptoms. Laparoscopic cholecystec-
tomy was performed without any cardiac complication.
Department of Cardiology, Goztepe Medical Park Hospital,
Istanbul, Turkey
C SENGUL, MD,
H FOTBOLCU, MD
K OZDEN, MD
Department of Cardiology, Haydarpasa Numune Education
and Research Hospital, Istanbul, Turkey
D DUMAN, MD
Fig. 1. Spider view shows multiple coronary artery fistu-
lae originating from the LAD and CX coronary arteries.
LAD: left anterior descending artery CX: circumflex
artery.
Fig. 2. Right anterior oblique view shows contrast opaci-
fication of the left ventricle by fistulae in systole.
