Stress/Rest 99mTc-MIBI SPECT and 123I-BMIPP scintigraphy for indication of surgery with coronary artery to pulmonary artery fistula

A 45-year old man was admitted to our hospital with chest pain occurring suddenly upon exercise and disappearing with test within several minutes. A continuous murmor was heard at the Upper sternum border. Conventional electrocardiography showed no evidence of myocardial ischemia. Coronary angiography and cardiac catheterization demonstrated a fistula originating from the left coronary artery to the pulmonary artery with an aneurtsm 2 cm in size, and Qp/Qs 1.08. Treadmill exercise testing showed no ST-T chance at the maximum heart rate of 160 beats/min. Stress/Rest (99m)Technetium-MIBI single-photon emission computed tomography (SPECT) and (123)1-15-(p-iodo-pheny1)-3,R,S-methylpentadecanoic acid (BMIPP) scintigraphy were performed to evaluate myocardial ischemia and ischemia was identified at the perfusion area of the left anterior descending artery. From these results, the patient was diagnosed as having a coronary artery to pulmonary artery fistula with myocardial ischemia. Consequently, surgical treatment was chosen Under cardiopulmonary bypass. The determination of a surgical indication Using stress/rest Tc-99m-MIBI SPECT and BMIPP scintigraphy is useful in cases showing normal TMT, such Lis this case.