Case Report
 
Severely ectatic left circumflex coronary artery with fistula to coronary sinus presenting with acute coronary syndrome
Ahmed Sayed
MD, Department of Cardiology, University of Calgary, Calgary, Canada.

doi:10.5348/ijcri-2013-12-421-CR-15

Address correspondence to:
Ahmed Sayed
MD, Department of Cardiology
University of Calgary
Calgary
Canada
Email: sayed326@yahoo.com

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How to cite this article
Sayed A. Severely ectatic left circumflex coronary artery with fistula to coronary sinus presenting with acute coronary syndrome. International Journal of Case Reports and Images 2013;4(12):727–730.


Abstract
Introduction: malies. They occur in 0.1–0.8% of patients undergoing coronary arteriography. The circumflex coronary arteriovenous fistulae (CAF) associated with aneurysmal dilatation and drainage into coronary sinus (CS) are even less common. We present a case of a 56-year-old male with an acute coronary syndrome who was found to have a tortuous and aneurysmal circumflex coronary artery terminating into the CS.
Case Report: A previously healthy 56-year-old male developed acute retrosternal chest pain while skiing. Physical examination revealed a grade II/VI continuous murmur at the left lower sternal border, but was otherwise unremarkable. Laboratory investigations revealed an elevated troponin and ST depression in the inferior leads on his electrocardiography. Coronary angiography showed a diffusely aneurysmal circumflex artery with a fistula to the CS. The patient underwent successful surgical ligation of the fistula.
Conclusion: Our patient presented with an acute coronary syndrome caused by an uncommon form of coronary artery fistula. Conventional coronary angiography failed to fully define the anatomy of the fistula (origin, pathway, and outflow). Multidetector computed tomography was complementary to demonstrate the complex anatomy of the fistula. The fistula was surgically ligated and he remains well.

Keywords: Coronary artery fistula, Coronary artery angiogram, Acute coronary syndrome


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Author Contributions
Ahmed Sayed – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© Ahmed Sayed 2013; This article is distributed the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any means provided the original authors and original publisher are properly credited. (Please see Copyright Policy for more information.)