Fistula between the left anterior descending coronary artery and the pulmonary artery causing angina in two middle-aged patients.

Congenital coronary artery fistulas usually originate from the right coronary artery. Patients with such fistulas rarely reach middle age without symptoms or complications. In the cases presented here, a congenital fistula between the left anterior descending coronary artery and the pulmonary artery was discovered in a 55-year-old man and a 41-year-old man who were being evaluated for angina. The first patient also had coronary artery disease. Both fistulas were successfully treated with ligation and division.