Congenital coronary artery fistula as a cause of angina pectoris

Coronary artery fistula (CAF) is an abnormal precapillary connection between a coronary artery and neighboring structures, such as the right atrium, right ventricle, pulmonary artery, superior vena cava, or coronary sinus. It is observed in 0.1% to 0.2% of coronary angiographic studies. This infrequent abnormality can be seen at any age. Although a CAF may originate from any site of the three major coronary arteries, including the left main trunk, it usually arises from the right coronary artery or left anterior descending artery. The circumflex coronary artery is rarely involved.