Bilateral coronary artery to pulmonary trunk fistulae detected by coronary angiography and evaluated by ECG-gated SPECT myocardial perfusion imaging: report of two cases

Coronary artery fistulae (CAF) are anomalies related to coronary artery abnormal termination. This is a very rare congenital malformation accounting for about 0.2–0.4% of congenital cardiac anomalies, but in some patients it can be haemodynamically important. Single-photon emission computed tomography or positron emission tomography myocardial perfusion imaging (MPI) using radioactive agents is widely used in clinical practice for cardiac ischaemia detection as a very sensitive and non-invasive tool. We are going to present 2 patients with bilateral CAFs to the pulmonary trunk without signs of the rest or stress ischaemia in MPI.