Acquired coronary fistula after left ventricular de-airing by apical needle aspiration

Acquired coronary fistula is uncommon, but has been reported to occur after several surgical procedures, acute myocardial infarction, endomyocardial biopsy, coronary angioplasty, and thoracic trauma. We describe the occurrence of a left coronary to left ventricular cavity fistula following resection of a left atrial myxoma, with spontaneous closure in the following weeks. The fistula was likely caused by a needle inserted into the left ventricular apex, a procedure routinely used to ensure left ventricular de-airing.