Coronary-Cameral Fistula to Pulmonary Artery: An Innocent Bystander?

Coronary-cameral fistula (CCF) is a rare congenital communication between a coronary artery and a cardiac chamber or a great vessel. Most patients are asymptomatic and these lesions are incidentally detected during coronary angiography, with the reported incidence being up to 0.2%. The most frequent draining sites are right ventricle, right atrium, and pulmonary arteries, with less frequent drainage to the left side of the heart. The majority of CCFs are hemodynamically inconsequential and do not require treatment. However, when large, these lesions can cause myocardial ischemia by causing coronary steal or high-output heart failure, and should be treated. Treatment modalities include transcatheter closure with embolic agents (microcoil or gelfoam) and surgical ligation. Choice of therapy is governed by size of the CCF, tortuosity of the feeder channel, size of the communication to prevent embolization, and concomitant coronary artery disease.