[Left coronaroventricular microfistula].

Abstract

Left coronaroventricular microfistulae is a rare malformation. The authors report 11 cases of microfistulae between coronary arteries and left ventricle diagnosed by coronary arteriographies. These cases include 6 men and 5 women. Patient's mean age was 54.4 years. The symptoms were suggestive of coronary pathology. The ECG showed myocardial ischemia signs in 5 cases. The other patients had a positive exercise-test. Microfistulae originated from the left anterior descending artery were seen in 5 cases, from the right coronary artery in 2 cases, from the circumflex in 1 case and from the lateral artery in 1 case. The microfistulae originated from both left anterior descending artery and right coronary artery were observed in 2 patients. The main mechanism of myocardial ischemia seems to be related to the coronary steal phenomenon. The diagnosis of the microfistulae is based on coronary arteriography with late recorder angiographic images. The treatment is essentially medical. Surgical and transcatheter treatments are exceptional and must be considered in only severe forms with refractory medical treatment.