[Angina and myocardial ischemia related to a fistula between the anterior interventricular artery and the pulmonary artery in a 56-year-old man].

The authors report a case of fistula between the left anterior descending artery (LAD) and the pulmonary artery (PA), in which the only clinical expression was angina associated with electrical signs of myocardial ischaemia on exertion. In the absence of any other signs of left-right shunt related to the fistula, the initial diagnosis was that of atherosclerotic coronary artery disease, especially as this 56-year-old man presented three risk factors. Coronary angiography revealed this anomaly and corrected the diagnosis. Surgical closure of the fistula under cardiopulmonary bypass and via a pulmonary artery approach led to resolution of the angina and exertional ischaemia. Similar cases of LAD-PA fistula responsible for angina as the only clinical manifestation and discovered on coronary angiography have been rarely reported in the literature.