[Silent coronary artery-left ventricular fistula and acute myocardial ischemia].

A 65-year-old woman developed severe coronary insufficiency associated with papillary muscle dysfunction. She was submitted to cineangiocoronarography which ruled out obstructive coronary disease. Coronarography revealed a communication between the coronary arteries and the left ventricle, but a coronary arterial fistula was not seen. The possibility of this uncommon form of coronary drainage to the left ventricle, named silent fistula, being the cause of myocardial ischemia related to the coronary steal phenomenon is discussed.