Bilateral coronary artery fistula: Case report and overview

A case is presented of an atypical arteriovenous coronary artery fistula which occurred in a young man who was admitted to hospital with constant stress-dependent dyspnea and a feeling of thoracic constriction. A continuous systolic-diastolic murmur above the 5th intercostal space to the left of the sternum was present. By means of transoesophageal echocardiography and heart catheterization a rather atypical bilateral coronary fistula was found. A bilateral coronary fistula had been formed from RCA and RCX which drained via a common intramural cavity into the right ventricle. The fistula was operatively closed. Bi-lateral coronary artery fistula are rare, being found with a frequency of 0.002-0.013% in heart catheterization. In 36 reported instances of bilateral fistulae it has been noted that drainage into the pulmonary artery is more common than is the case with single coronary artery fistulae. The therapeutic considerations correspond with those for single fistulae.