"Reverse steal phenomenon" in a patient with coronary artery disease and coronary-left ventricular fistula

Coronary artery fistulas (CAFs) are infrequent congenital malformations, although some may be acquired: iatrogenic (during thoracic surgery or PCI) or traumatic. The incidence of CAFs has not been well defined but it is found in less than 0.2% of angiographic examinations. CAFs, even if rarely, may cause heart failure, spontaneous intrapericardial rupture or myocardial ischemia due to coronary "steal phenomenon". The literature reports very few cases of patients where a CAF was associated with a coronary artery disease (CAD). The consequences of this association on coronary haemodynamics and myocardial blood flow (BF) was poorly investigated.