Detection of Coronary Artery Fistula between the LAD and the Great Cardiac Vein on Coronary CT Angiography

Coronary artery fistulas (CAFs) are abnormal communications of coronary arteries whereby venous circuits bypass the normal capillaries within the myocardium. Coronary artery-to-cardiac vein fistula is the third most common type of CAF, accounting for 7% of cases. Electrocardiographic-gated cardiac computed tomographic (CT) angiography has emerged as a noninvasive alternative method of choice for diagnosis due to its high spatial and temporal resolution and short acquisition time. Herein, we aimed to present a left anterior descending coronary artery opened into the greater cardiac vein at the distal level, consistent with a coronary artery-to-cardiac vein fistula in a 77-year-old woman. Coronary artery CT angiography provides a detailed evaluation of the complex anatomy of coronary artery fistula without the need for invasive methods.