Prominent Systolic Coronary Flow in a Coronary Artery Fistula with a Giant Aneurysma

A 68-year-old Japanese woman was admitted to hospital because of chest oppression during exertion. Coronary angiography showed a coronary artery fistula with a giant aneurysm, which originated from both the left anterior descending (LAD) and right coronary arteries. We investigated coronary blood flow velocity using the Doppler guide wire technique. The coronary flow pattern showed a very prominent systolic component, whereas the diastolic flow components were nearly normal before the operation at the LAD site proximal to the coronary artery fistula. This pattern returned to normal after the operation. This report describes the relationship between the coronary steal phenomenon and coronary flow dynamics investigated directly using the Doppler guidewire technique.