Myocardial ischemia due to a large coronary-pulmonary fistula with plexus-like morphology.

Congenital coronary-pulmonary artery fistula is a rare anomaly. We report the case of a coronary-pulmonary artery fistula with plexus-like morphology connecting the left main stem and proximal segments of the left anterior descending and circumflex coronary arteries to the main pulmonary artery in a 69-year-old woman. It caused inducible ischemia as revealed by myocardial perfusion tetrafosmin scintigraphy (Tc-99m SPECT). To our knowledge, no case of a large plexus-like coronary-pulmonary artery fistula from the very proximal left coronary artery has been reported. Furthermore, only a few cases report scintigraphic demonstration of severe ischemia in such a coronary anomaly.