Multiple coronary-cameral fistulae.

A 56-year-old man with no known cardiac risk factors presented with dyspnea upon exertion. The vital signs were normal. Echocardiography showed normal left ventricular (LV) ejection fraction and no valvular disease, but moderate LV hypertrophy and LV diastolic dysfunction were noted. Rest and stress myocardial perfusion scintigraphy showed a reversible inferior-wall perfusion defect; therefore, an initial diagnosis of coronary artery disease was made. Coronary arteriography showed no atherosclerotic lesions in the 3 major coronary arteries; however, all 3 arteries communicated with the LV cavity through many small, diffuse fistulae (Figs. 1 and 2), resulting in complete LV contrast opacification. The coronary sinus appeared to be of normal size. The inferior-wall ischemia that was shown on nuclear stress imaging was attributed to coronary steal phenomenon. The patient was placed on medical therapy. Images In Cardiovascular Medicine