Dual coronary - cameral fistula "double the trouble".

A patient presenting with worsening dyspnea and left-sided chest pain underwent heart catheterization, found to have a rare connection between the right and left coronary arteries draining into the left ventricle, consistent with dual coronary-cameral fistula.

CASE PRESENTATION

An 80‐year‐old male presented with worsening dyspnea and chest pain. The nuclear stress test was positive for ischemia in the basal inferoseptal/basal inferior and septal walls. Coronary angiogram showed mild coronary artery disease, however, noted coronary‐cameral fistulas (CCF) arising from both the right coronary artery (RCA) and left anterior descending artery (LAD) (Figure 1, 2).

FIGURE 1

Antero‐posterior caudal view of right coronary artery, showing highly tortuous distal artery and terminating to numerous small fistulas draining into the left ventricle

FIGURE 2

Right anterior‐oblique caudal view of left anterior descending artery, showing highly tortuous distal artery and terminating to numerous small fistulas draining into the left ventricle

WHAT ARE CORONARY ARTERY FISTULAE AND WHAT DO WE DO IN THIS CASE?

Coronary artery fistulae (CAF) are rare abnormal connections of the coronary artery to another artery or heart chamber. Around 55% of cases involve the RCA and about 35% involve the left coronary arteries. The majority of CAF connect with the right ventricle or atria, while only around 3% connect into the LV. Here, we present a rare case where two coronary arteries, the RCA and LAD, create fistulas with the LV cavity, consistent with dual CCF. Most cameral fistulas are benign; however, they can cause ischemia due to the coronary steal phenomenon. Depending on the size of the fistula medical, surgical and percutaneous options have been utilized. In our case, the patient was deemed not suitable for closure of the fistulae due to small/multiple fistulae and therefore was managed conservatively.

CONFLICT OF INTEREST

None declared.

AUTHOR CONTRIBUTIONS

JK and SS: were the physicians in charge of the patient throughout hospitalization and follow‐up. SS, MR, and JK: prepared the manuscript draft, which was critically revised and approved by JK and MR.

CONSENT STATEMENT

Informed consent was obtained from the patient to publish his case and medical images. No ethical committee approval was required for the publication of this case report.

Video S1

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Video S2

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