Acute coronary syndrome or steal phenomenon - a case of right coronary to right ventricle fistula.

We report a case of 53-year-old male admitted to the hospital with severe chest pain and elevation of troponin I levels, who was transferred to our department for a coronary angiography. Contrast injection into the right coronary artery (RCA) demonstrated no evidence of coronary artery disease. However, a double outlet coronary artery fistula which drained into the right ventricle was visualised. With standard 2-dimensional echocardiographic imaging abnormal flow was detected in the inflow part of the right ventricular free wall. Three-dimensional colour Doppler imaging clearly demonstrated the presence of double outlet RCA - right ventricle coronary fistula with sufficient quality.