Discussion:
Coronary artery fistulae (CAF) are rare abnormal connections of the coronary artery to another artery or heart chamber. Fistulas are mostly congenital in origin but can be acquired. 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. Other complications include diastolic volume overload related heart failure, endarteritis and arrhythmias. Depending on the size of the fistula medical, surgical and percutaneous options have been utilized.