A 66 year old woman was admitted to other hospital suffering from chest pain. After the treatment as non-ST elevation myocardial
infarction, she was transferred to our clinic for angiographic evaluation. There was no evidence of reminiscent coronary
artery-pulmonary artery fistula on transthoracic echocardiography. Coronary angiography showed significant stenosis at distal left
anterior descending artery (LAD), its diagonal branch, and first obtus marginus. Two fistulas originating from LAD and RCA and join
to pulmonary artery were seen in angiographic scenes. No ischemia was seen in RCA perfusion zone by myocardial scintigraphy.
Because of the small lumen diameter of the distal LAD and mild shunt ratio (Qp/Qs:1.1) calculated with second echocardiographic
examination after angiography, medical therapy was the final choice of treatment.