Bilateral coronary artery fistulas terminating at the same location case report

Dual coronary fistulas complicated with significant left to right heart shunt in an elderly patient

“…The most common proximal communication arises from right coronary artery followed by left anterior descending artery and the distal communication most commonly occurred in the pulmonary artery [1]. Dual coronary artery fistula occurred infrequently which mostly arise from the right coronary artery and left descending artery [2][3][4] which was also seen in our case.…”

Myocardial ischemia secondary to dual coronary artery fistulas draining into main pulmonary artery

“…It usually drains in right heart chambers, most commonly in right ventricle (40%), followed by in right atrium (25%), pulmonary artery (15-20%) and in coronary sinus (7%) [3]. Most of the published case reports have demonstrated dual fistula from right coronary and left anterior descending coronary artery draining into pulmonary artery [4][5][6], however the combination of right coronary and left circumflex coronary fistula to pulmonary artery as present in the index case is not being reported earlier in published English literature. An embryological basis in the form of persistence of coronary artery anlagen at pulmonary sinus and immature supernumerary coronary artery communication between pulmonary sinus and coronary artery had been explained for this uncommon coronary anomaly [6,7].…”