Myocardial ischemia assessed by dobutamine stress echocardiography in a patient with bicoronary to pulmonary artery fistulas.

A congenital coronary artery fistula is a rare anomaly characterized by a communication between one or more coronary arteries and a cardiac chamber, coronary vein, or less frequently, the pulmonary artery. The reported complications of this anomaly are congestive heart failure, infective endocarditis, and myocardial infarction. Although angina is not an infrequent complaint in the adult population with coronary to pulmonary artery fistulas, objective evidence of myocardial ischemia in the absence of concomitant atherosclerotic coronary artery disease has not been described. In this report, we describe an adult patient with chest pain and bicoronary to pulmonary artery fistulas in whom myocardial ischemia was documented by high-dose dobutamine stress echocardiography.