MYOCARDIAL-ISCHEMIA ASSESSED BY DOBUTAMINE STRESS ECHOCARDIOGRAPHY INA PATIENT WITH BICORONARY TO PULMONARY-ARTERY FISTULAS

A congenital coronary artery fistula is a rare anomaly characterized b y 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, i nfective endocarditis, and myocardial infarction. Although angina is n ot an infrequent complaint in the adult population with coronary to pu lmonary artery fistulas,(4) 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 w ith chest pain and bicoronary to pulmonary artery fistulas in whom myo cardial ischemia was documented by high-dose dobutamine stress echocar diography.