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A 70-year-old man presented with unstable angina with dynamic ECG changes in the setting of staphylococcal sepsis. His background includes end-stage renal failure requiring haemodialysis and coronary bypass grafting.
Coronary angiography confirmed patent left-sided grafts and a large fistula from the mid-right coronary artery (RCA) to the right ventricle (RV) (figure 1), causing a large left-to-right shunt and consequent steal phenomenon with RCA territory ischaemia. This fistula was not present at angiography 2 years prior and was …
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