Multivessel coronary-ventricular fistulae and ischaemia on cardiac MRI.

Multivessel coronary ventricular fistulae is a rare coronary anomaly whose origin is believed to be from an arterioluminal or arteriosinusoidal connection with the ventricle. The clinical and haemodynamic significance of these fistulae have been a source of controversy despite varying methods of evaluation. A 69 year old female with exertional dyspnoea, atypical chest pain and multivessel coronary to left ventricular fistulae underwent cardiac MRI with adenosine stress. Subendocardial ischaemia was present in multiple coronary territories therefore confirming a coronary steal phenomenon.