Left ventricular steal syndrome caused by multiple plexiform coronary artery fistulae: case report, literature review and treatment

Abstract

Coronary artery fistulae (CAF) consist of termination abnormalities of coronary arteries. Here in, we present a case of multiple CAF and would like to discuss the treatment approaches of this type of CAF. A 62 years old woman presented with resting chest pain. Selective coronary angiography revealed cameral fistulae of all three coronary arteries to left ventricle (CA-LV). In the light of the worsening of angina under nitrate and dihydropyridine group calcium channel blocker therapy, reducing heart rate with a β-blocker and ivabradine in patients with sinus rhythm may be effective for angina control in treatment of CA-LV cameral fistulae.