Case presentation:
An 80-year-old male with a history of diabetes-mellitus presented with
worsening dyspnea and chest pain. The nuclear stress test was positive
for ischemia in the basal inferoseptal/basal inferior, and septal walls.
Coronary angiogram showed mild coronary artery disease, however noted
coronary-cameral fistulas (CCF) arising from both the right coronary
artery (RCA) and left anterior descending artery (LAD) (Figure AB. Video
1& 2). We conclude his symptoms are related to the significant coronary
to left ventricle (LV) shunt due to these dual coronary fistulas. The
patient was deemed not suitable for closure of the fistulae due to
small/multiple fistulae and therefore was managed conservatively.