Percutaneous closure of the coronary artery-pulmonary artery fistula in a patient with apical hypertrophic cardiomyopathy

A fifty-four-year-old female patient was admitted to our unit with exertional chest pain of six months duration. Transthoracic echocardiography showed apical hypertrophy. Cardiac magnetic resonance imaging performed for differential diagnosis revealed apical hypertrophic cardiomyopathy. The patient underwent myocardial perfusion scintigraphy with the indication of chest pain which showed anterior ischemia. Coronary angiography revealed an arteriovenous fistula (AVF) extending from the proximal segment of the left anterior descending artery to the pulmonary artery. The patient's existing complaints were attributed to a coronary steal syndrome secondary to the coronary AVF. The AVF fistula was closed with a coil and the patient's chest pain improved. In conclusion, coronary steal syndrome may lead to myocardial ischemia in patients with a coronary AVF.