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Making the Connection: Incidental finding of Coronary Artery Fistula

Coronary artery fistulas (CAF) are rare congenital or acquired coronary artery anatomic anomalies. They can develop from any of the three coronary arteries and drain into any of the cardiac chambers and great vessels thus creating an anatomic bypass of the myocardial capillary network. In our case, we present an 81-year-old who was referred for left heart catheterization after having found myocardial ischemia on perfusion imaging. Incidentally, he was found to have a fistula connection between the left circumflex coronary artery with the pulmonary artery. We present an atypical case of a circumflex coronary artery as a rare point of origin for a fistula with an incidence of about 18%.