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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 …
Contributors WW is the primary author and performed the initial procedure. He created the images using Photoshop. IG assisted with drafting the case report and assisted in the second case. NC was the consultant for both cases and supervised/revised the manuscript.
Competing interests None.
Patient consent Obtained.
Provenance and peer review Not commissioned; internally peer reviewed.