Sequential Management of Coexisting Aorta-to-Pulmonary and Coronary-to-Pulmonary Vein Fistulae

In a 42-year-old man who presented with exertional dyspnea, a large fistula between the pulmonary vein and the left circumflex artery, and multiple aorta-to-pulmonary vein fistulae, were observed on coronary computed tomographic and magnetic resonance angiograms. Surgical ligation of the coronary artery-to-pulmonary vein fistula and coil embolization for two aorta-to-pulmonary vein fistulae were performed sequentially. The patient's symptoms were relieved after fistula occlusion and recovery of hemodynamic values.