We present a case of giant coronary arteriovenous fistula between left main coronary artery and pulmonary artery in a 60-year-old female who presented with anginal symptom. Dobutamine stress echocardiography and myocardial perfusion scan with (99m)Tc-MIBI revealed a reversible perfusion defect in the septal region. Coronary angiography demonstrated a giant coronary arteriovenous fistula origination from the left main coronary artery and draining into the pulmonary artery. This appears to be the first case in which dobutamine stress echocardiography and myocardial perfusion scan with (99m)Tc-MIBI demonstrated myocardial ischemia due to coronary steal in patient with a coronary arteriovenous fistula.
Arteriovenous Fistula* ; Coronary Angiography ; Coronary Vessels ; Dobutamine* ; Echocardiography, Stress* ; Female ; Humans ; Middle Aged ; Myocardial Ischemia ; Perfusion ; Pulmonary Artery ; Septum of Brain ; Tomography, Emission-Computed, Single-Photon*

If ventricular fibrillation develops after acute myocardial infarction, it should be treated immediately with the external electrical cardioversion and antiarrhythmic agents, followed by the rapid correction of the reversible and underlying cause. Nevertheless, if ventricular fibrillation recurs, ICD(implantable cardioverter-defibrillator) therapy is necessary. ICD is an important nonpharmacological option in the treatment of malignant ventricular arrhythmias. A 53 year old man was admitted into our hospital with a severe chest pain of 9 days. On cardiac catheterization, a significant stenosis at the mid-left anterior descending coronary artery and a huge ventricular aneurysm were found. Then PTCA(percutaneous transluminal coronary angioplasty) with a stent was taken. Three days later, two episodes of ventricular fibrillation developed and it was treated with electrical cardioversion and antiarrhythmic agents. On the second look of cardiac catheterization, a subacute closure of the stented site was detected and then the culprit leision was recanalized with repeated PTCA and another stent was implanted. But ventricular fibrillation recurred although the stented lesion still patent on the third look of cardiac catheterization. After all, we implanted ICD on him. 46 Episodes of ventricular fibrillations developed at the same day and the next day of ICD implantation. All of the episodes of ventricular fibrillation were successfully converted to sinus rhythm with shocks from ICD. Since then, the frequency of ventricular fibrillation decreased with IABP(intraaortic balloon pump) therapy. We report the first case of malignant ventricular fibrillation after myocardial infarction which was uncontrolled with conventional therapy, but effectively treated with ICD.
Aneurysm ; Arrhythmias, Cardiac ; Cardiac Catheterization ; Cardiac Catheters ; Chest Pain ; Constriction, Pathologic ; Coronary Vessels ; Electric Countershock ; Humans ; Middle Aged ; Myocardial Infarction* ; Shock ; Stents ; Ventricular Fibrillation*