Images in Clinical Medicine

Kim Eagle, M.D., Editor

Coronary Arteriovenous Fistula on Coronary Angiography

Kenichi Fujise, M.D., and Warren Sherman, M.D.

N Engl J Med 1994; 331:1265November 10, 1994

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Article

Figure 1 Coronary Arteriovenous Fistula on Coronary Angiography.

A large coronary arteriovenous fistula can be seen originating in the left coronary artery, coursing over the lateral and posterior walls of the left ventricle, and eventually emptying into the right atrium. The solid arrow indicates the origin of the fistula (not well visualized), and the open arrow indicates a normal-sized left anterior descending coronary artery, which is of much smaller caliber than the greatly dilated fistula. Patients with such fistulas often have loud continuous cardiac murmurs and may have congestive heart failure, myocardial ischemia (due to a coronary-artery ”steal” phenomenon), and pulmonary hypertension. Coronary arteriovenous fistulas typically arise as congenital anomalies. With obliteration of the fistula by suturing, the prognosis is usually excellent.

Kim Eagle, M.D.

Kenichi Fujise, M.D.
University of Texas Health Science Center at Houston, Houston, TX 77030

Warren Sherman, M.D.
Beth Israel Medical Center, New York, NY 10003