Bilateral multiple coronary artery fistulae with angina pectoris and syncope

Coronary artery fistulae (CAF) are rare cardiac anomalies. They frequently arise from the right coronary artery (RCA) with fistulae originating from the left anterior descending artery (LAD) or from multiple arteries being less common. They do not usually cause symptoms and are incidentally diagnosed on routine cardiac imaging. We report a 70 years old male patient presenting with chest pain and syncope during physical activity. Diagnostic coronary angiography revealed bilateral multiple CAF originating from both the LAD and RCA. As high blood flow output was recognized in these large vascular anomalies contributing to ‘steal phenomenon’ surgical intervention was planned. This manuscript aimed to present the case and review the current literature for the management and treatment of these coronary anomalies.