Myocardial ischemia due to a coronary-to-pulmonary artery fistula proximal to an intermediate stenosis in the left anterior descending coronary artery: percutaneous closure by means of angioplasty and stent grafting.

This case report refers to a 46-year-old patient with symptomatic stable angina and myocardial ischemia documented at 99mTc-MIBI SPECT scintigraphy. Coronary angiography revealed a coronary artery fistula (CAF) and a non-significant stenosis of the left anterior descending coronary artery (LAD). We performed coronary angioplasty and stenting of the LAD and closure of the CAF using a covered stent. After the procedure the patient was asymptomatic and a myocardial scintigraphy, performed 6 months later, confirmed the absence of myocardial ischemia. This suggests that a CAF arising before a coronary stenosis may contribute to the genesis of myocardial ischemia, perhaps by giving rise to a steal phenomenon.