Bilateral fistulas: a rare cause of chest pain. Case report with literature review.

A coronary artery fistula is a direct communication between a coronary artery and one of the cardiac chambers or vessels around the heart. These fistulas are usually diagnosed by coronary arteriography. Clinical presentations are variable depending on the type of fistula, shunt volume, site of the shunt, and presence of other cardiac conditions. Bilateral coronary fistulas between coronary arteries and the pulmonary artery are very rare. This report describes a 51-year-old man without any previous medical history, who presented to our hospital one hour after the acute onset of severe substernal chest pain associated with shortness of breath and nausea. Coronary angiography revealed two fistulas arising from the left anterior descending and right coronary arteries and draining at exactly the same site in the pulmonary artery. There was no evidence of atherosclerotic coronary artery disease in either the left or right coronary arterial tree.