CAF can result in coronary steal
and left-to-right shunt which may further reduce the ventricular perfusion and increase diastolic volume overload.5 The factors influencing the clinical presentation and prognosis of the coronary to pulmonary artery fistula (CPAF) are the size of the communication, the amount of blood drained through it, the resistance of the recipient chamber, and development of myocardial ischaemia or infarction.6 The clinical diagnosis of coronary artery-pulmonary artery fistulae is difficult because clinical presentation, laboratory and ECG manifestations are usually nonspecific.
This prevents the potential risk of myocardial ischemia resulting from coronary steal
Although patients with coronary artery fistulas are frequently asymptomatic, it must be keep in mind that the fistulas can cause ischemic chest pain secondary to coronary steal
as well as LV hypertrophy caused by volume overload and increased oxygen consumption.
through anomalous internal mammary artery graft.
Early surgical interventions are advised to correct the coronary steal
syndrome and myocardial ischemia, and therefore establish a two coronary perfusion system that is mandatory for long-term survival.
This is known as the coronary steal
phenomenon.3 Circulatory insufficiency, myocardial infarction, and life-threatening cardiac dysrhythmias are the most common clinical presentations during infancy.2,3 Older patients carry the risk of sudden death due to myocardial infarction, left ventricular dysfunction and mitral regurgitation, or silent myocardial ischemia.
Proof of a coronary steal
. Am J Cardiol 1983;51(3):610-2.
Rarely, ALCAPA syndrome manifests in adults with symptoms of heart failure, mitral valve insufficiency, angina and/or myocardial ischemia due to the "coronary steal
In CAF, blood diverting from the high resistance myocardial capillary bed into the low resistance fistula produce ischemia and coronary steal
CCTA can detect coronary collateral circulation and coronary steal
phenomenon indicating a left to right shunt in these cases (4).
The exact mechanism involved for the symptoms are not known, but most authors believe this may be from a"coronary steal
phenomenon," which represents shunting of blood through the low resistant fistula.
For example, the statement "Perhaps the most striking example is the rise and fall of high-dose opioid anesthesia, which was initially driven by concern about excessive cardiac depression by volatile anesthetics in the 1970s and further accelerated in the mid 1980s by concerns about potential coronary steal