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Coronary artery fistulas are abnormal connections between the coronary arteries with a heart chamber or any of the major blood vessels. Fistulous connections between systemic arteries and pulmonary vessels are even less frequent. We present a case of a 71-year-old man with symptoms of dyspnea, exercise intolerance, and ventricular arrhythmia who attended the emergency department. Coronary angiography revealed bilateral coronary fistulas drained into the pulmonary circulation. Computed tomography angiography revealed the presence of fistulas arising from the descending aorta, right internal mammary artery, and subclavian arteries, all these drained into the pulmonary circulation. Due to the rarity of the disease, there are no international guidelines for the management of coronary fistulas and the treatment is controversial. Coronary artery fistula is a rare pathology that should be included in the differential diagnosis of heart failure and ventricular arrhythmia., (© 2023 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

We describe a patient with right coronary artery to coronary sinus fistula requiring surgical elimination. The decision process in managing fistulas depends on the size, site of origin, and symptoms caused by the fistula. We highlight the pivotal role of multimodality cardiovascular imaging in the diagnosis and management of coronary fistulas. ( Level of Difficulty: Intermediate. )., Competing Interests: The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

We present a case of a 56-year-old patient with a symptomatic right coronary artery to pulmonary artery fistula who underwent coil embolization. Post-procedure, the patient developed ventricular fibrillation that was refractory to antiarrhythmic medications and numerous attempts at defibrillation. ( Level of Difficulty: Intermediate. )., Competing Interests: The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2022 The Authors.)

Coronary artery fistulae connecting the left circumflex to the coronary sinus are rare. Surgical closure of coronary sinus connections is technically challenging because of the location, especially in high-risk surgical patients. We used multimodality imaging to delineate the drainage site and successfully closed a left circumflex to coronary sinus fistula using a transcatheter closure technique. ( Level of Difficulty: Advanced. )., Competing Interests: The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2022 The Authors.)

A 58-year-old man was admitted for stable angina. The coronary angiogram revealed a coronary-pulmonary fistula with a nonsignificant atheroma. We decided to perform percutaneous embolization of the fistula in view of the symptoms and the hemodynamic assessment findings. Embolization was performed using a liquid embolic agent with no residual flow. ( Level of Difficulty: Intermediate. )., Competing Interests: The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2022 The Authors.)

Coexistence of coronary artery-to-left ventricle fistula (CALVF) and noncompaction cardiomyopathy (NCC) is rare in patients with severe multiple coronary stenosis. We report CALVF in a 70-year-old man with acute coronary syndrome (ACS) and NCC. Left ventricular ejection fraction may not improve by total revascularization in this condition. ( Level of Difficulty: Advanced. )., Competing Interests: The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2022 The Authors.)

This report describes the case of a symptomatic patient with a right coronary artery fistula draining into the coronary sinus who underwent transcatheter closure, which was deployed in the drainage site to seal off the exit of the fistula. ( Level of Difficulty: Advanced. )., Competing Interests: The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2021 The Authors.)

An asymptomatic patient presented at our hospital exhibiting a Brugada electrocardiography pattern with coronary artery fistulas. Coronary artery fistula is a congenital or acquired rare abnormal condition with increased symptoms and complications over time. In the absence of the therapeutic consensus, we discuss the association and management for this condition. ( Level of Difficulty: Advanced. )., Competing Interests: The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2021 The Authors.)

Coronary artery aneurysm and pseudoaneurysm are rare and mainly result from atherosclerosis. We present a successfully treated case of a giant right coronary artery aneurysm and pseudoaneurysm with a coronary artery fistula, which might have developed after cardiac surgery for a right ventricular tumor 35 years earlier. ( Level of Difficulty: Advanced. )., Competing Interests: The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2021 The Authors.)

A 52-year-old woman presented with a continuous heart murmur at an annual health examination. Coronary computed tomography angiography showed confluent coronary artery fistulas meeting to form a large aneurysm fistulizing to the pulmonary artery. Percutaneous coil embolization was performed, resulting in the disappearance of the coronary artery fistulas and aneurysms. ( Level of Difficulty: Intermediate. )., (© 2020 The Authors.)

Coronary artery fistula (CAF) is an abnormal connection between a coronary artery and a heart chamber resulting in left-to-right shunt. A large CAF was an unexpected cause of heart failure in a 58-year-old woman who underwent transcatheter closure of the CAF with improvement in symptoms but complicated by myocardial infarction. ( Level of Difficulty: Beginner. )., (© 2020 The Authors.)