Concomitant left and right coronary to bronchial artery fistulae resulting in myocardial ischaemia.

Fig. 2. The changes of myocardial ischaemia resulting from steal phenomenon were demonstrated by Thallium-201 myocardial perfusion scan (A-1: pre-embolisation, A-2: post-embolisation). Computed tomographic scan showed that the convoluted fistulous tract, originating from left circumflex coronary artery, passed through the subcarinal and left hilar region. These tortuous fistulae divided into multiple branches, which communicated with the left bronchial collateral circulations (B: arrow — the passage of convoluted fistula originating from left coronary artery, arrow head — the origin of right coronary fistulous tract). The patient was discharged on the 2nd postprocedural day without any other complications. Ao, aorta; LA, left atrium; LPA, left pulmonary artery; MPA, main pulmonary artery; RA, right atrium; RPA, right pulmonary artery.