Bi-directional flow in coronary-to-left ventricular fistula.

Coronary artery fistulae are rare congenital anomalies occasionally observed during coronary angiography. We present a case of retrograde coronary opacification during left ventriculography. This is the first reported case of angiographically documented bi-directional flow in these structures. Due to advanced age and personal wishes, the patient was treated medically. The epidemiology, pathophysiology, and therapy for coronary fistulae are briefly discussed.