Left coronary arteriovenous malformation with fistulous connections to the left and right ventricles

Abstract

A 20-year-old man with right bundle branch block in recordedECG was referred to our department. His physical examinationwas unremarkable. Transthoracic echocardiography showeda severe hypertrophy of the interventricular septum (22 mm)which contained multiple echo-free spaces of the vascularnature. A flow pattern suggestive to a coronary artery fistulainto the left ventricle was recorded. The patient was referredfor a coronary angiography, which revealed an arteriovenousmalformation starting from the septal branch of the enlarged leftanterior descending artery. The malformation communicatedwith the lumen of the left (arterial phase) and right ventricle(venous phase) as well. The posterior descending artery wasfed exclusively from the described arteriovenous malformation.99mTc MIBI SPECT images showed a moderately reversible perfusiondefect in the inferior wall, suggesting non-critical ischemiaof this region.