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Congenital coronary arteriovenous fistula is a relatively rare anomaly that can cause severe symptoms, especially in older patients.
A 69 year old woman presented complaining of a recent onset of angina. She had a positive exercise test at intermediate workload (angina and ST segment depression ⩾ 2 mm). Coronary angiography revealed the absence of obstructive disease of the epicardial vessel, while an evident arteriovenous fistula originating from the mid portion of the left anterior descending coronary artery was documented. The drainage site of the isolated fistula was the trunk of the pulmonary artery. The malformation was successfully occluded by the percutaneous embolisation of four Guglielmi detachable platinum coils (Target Therapeutics, Fremont, California, USA).
The patient was discharged the day after the procedure and was completely asymptomatic three months later.