Stress MIBI scintigraphy in multiple coronary-pulmonary fistula: failure to demonstrate "steal" phenomenon.

Stress radionuclide studies were performed in a patient with angiographically proven multiple coronary-pulmonary fistulas, in the presence of atypical chest pain. MIBI scintigraphy showed no myocardial perfusion defects. Multigated ventriculography showed an ejection fraction of 68% and 80% at rest and following exercise, respectively. Three separate fistulas were present between each coronary artery and the pulmonary trunk. The Qp:Qs ratio was 1.3. In the presence of atypical chest pain, stress MIBI scintigraphy and multigated ventriculography both failed to reveal myocardial ischemia in a 49-year-old patient with multiple coronary-pulmonary fistulas. She is using no medication, but advice concerning endocarditis prophylaxis was given.