Mehmet KIŞ, Çisem OKTAY, Mustafa Mahmut BARIŞ
Eurasian Journal of Emergency Medicine - 2026;25(1):377-381
Coronary cameral fistulas (CCF) are rare anomalies that can lead to significant morbidity due to abnormal coronary shunting, which may result in coronary steal, volume overload, and aneurysmal dilatation of the affected segments. Current guidelines recommend that the management strategy-whether conservative follow-up, percutaneous intervention, or surgical closure-be individualized by a multidisciplinary team with expertise in congenital heart disease, while carefully considering the fistula's origin, drainage anatomy, haemodynamic impact, patient age, and comorbidities. We report a rare case of a 66-year-old woman with multiple CCFs involving all three major coronary arteries, which were incidentally detected during elective coronary angiography. To evaluate potential myocardial ischemia secondary to coronary steal, cardiac magnetic resonance imaging was performed, revealing no pathological signal abnormalities. Following a multidisciplinary heart team evaluation, a conservative management strategy was adopted due to the absence of significant functional impairment. The patient has remained asymptomatic throughout a two-year follow-up period. This case underscores the critical importance of functional assessment over anatomical complexity in guiding clinical management, highlighting that multimodality imaging is essential for identifying patients who can safely avoid unnecessary invasive interventions.
