A Case of Multiple Coronary Artery-Left Ventricular Micro Fistulae Complicated With Hepatic Arteriovenous Fistulae

We present the first case of multiple coronary artery-left ventricular micro fistulae complicated with hepatic arteriovenous fistulae (AVF) in an adult patient. Multiple coronary artery fistulae originated from the left anterior descending coronary artery with aneurysmal change. Multiple coronary artery left ventricular micro fistulae presented on the left ventricular wall and showed significant localized hypertrophic change. Stress and enhanced cardiac magnetic resonance imaging (CMR) revealed myocardial ischemia that could not be detected by stress T1-201 cardiac scintigraphy, and late patchy gadolinium enhancement (LGE) in the mid-ventricular wall apex. This LGE pattern did not match the typical pattern observed in patients with apical hypertrophic cardiomyopathy. These observations may help distinguish multiple coronary artery-associated myocardial ischemia and hypertrophy from apical cardiomyopathy.