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Multiple septal coronary cameral fistulas may cause myocardial ischemia/Coklu septal koroner kameral fistuller miyokardiyal iskemiye neden olabilir.

Coronary artery fistulas can be between an epicardial coronary artery and a cardiac chamber (coronary- cameral fistulae). Depending on the type of fistula, shunt volume and site of the shunt the clinical presentations are changing. A 70-year-old female with past medical history of hypertension was admitted to our clinic with chest pain that related with exercise. Blood pressure and heart rate were 145/90 mmHg and 78 bpm respectively. Heart and respiratory auscultation findings were normal. There were dynamic changes of electrocardiogram with ST segment depression on V1-4 leads during the chest pain on an outside center which are resolved during presentation to our clinic. Transthoracic echocardiography showed normal left ventricular (LV) systolic function (ejection fraction: 68%) and no severe valvular heart disease. Myocardial perfusion scintigraphy showed anterior and anteroseptal wall ischemia. Coronary angiography showed no critical atherosclerotic lesions in the coronary arteries; however, septal arteries communicated with the LV cavity through multiple small, diffuse fistulas, resulting in complete LV endocardium contrast opacification (Fig. 1A, B and Video 1, 2. See corresponding video/movie images at www. On the diastole phase of the LV the endocardium was opacified and it was vanished during the systole phase when the septal fistulas were compressed. The anterior wall ischemia that was shown on nuclear stress imaging, chest pain and dynamic ST segment changes might be attributed to coronary steal phenomenon. Because of the diffuse nature of fistulas and the hardness of the process, surgical ligation or percutaneous endoluminal procedures were not considered. The patient was discharged from the hospital with medical treatment.

Video 1, 2. Multiple corono-cameral fistulas are clearly seen with cardiac cycle

Turgay Isik, Mahmut Uluganyan [1], Mehmet Gul [1]

Department of Cardiology, Faculty of Medicine, Balikesir University, Balikesir-Turkey

[1] Clinic of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul-Turkey

Address for Correspondence/Yazisma Adresi: Dr. Turgay Isik Balikesir Universitesi Tip Fakultesi, Kardiyoloji Anabilim Dali, Balikesir-Turkiye Phone: +90 266 612 14 55 Fax: +90 266 612 14 59 E-mail:

Available Online Date/Cevrimici Yayin Tarihi: 26.12.2012

doi: 10.5152/akd.2013.060

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Title Annotation:E-page Original Images/E-sayfa Ozgun Goruntuler
Author:Isik, Turgay; Uluganyan, Mahmut; Gul, Mehmet
Publication:The Anatolian Journal of Cardiology (Anadolu Kardiyoloji Dergisi)
Date:Mar 1, 2013
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