Miyokardiyal İskemi Oluşturan ve Sol Ventrikülografiyi Taklit Eden Kalıcı Tebesian Venlerin Ciddi Formu

Coronary artery fistula is a rare congenital anomaly. Thebesian veins are multiple coronary artery microfistula that cominicates coronary arteries and ventricles. Most patients with this anomaly are asymptomatic, but some patients may be symptomatic and have a presentation of myocardial ischemia, thrombosis and embolism, heart failure and arrhythmias. We present a case with exertional dyspnea and angina whose myocardial perfusion scintigraphy demonstrated inferior and apical defect with complete reversibility. Coronary angiography showed no coronary stenosis, but capillary blush draining into the left ventricular cavity through multiple microfistulae from the left anterior descending artery, circumflex artery and right coronary artery mimicking left ventriculography. Because of these small multiple fistulas are managed medically, the patient was discharged on a beta blocker, aspirin and ranolazine therapy. The patient stated a reduction in his symptoms one month later.