JOURNAL OF CASE REPORTS 2014;4(1):56-59 Selami Demirelli 1 , Muhammed Hakan Taş 2 , Ziya Şimşek 2 , Hakan Duman 1 , Emrah İpek 1 From the Department of Cardiology, Erzurum Training and Research Hospital 1 , Erzurum, Turkey; Department of Cardiology, Faculty of Medicine, Atatürk University 2 , Erzurum, Turkey. Coronary-to-Pulmonary Artery Fistula and Concomitant Acute Coronary Syndrome: Two Cases Journal of Case Reports, Vol. 4, No. 1, Jan-June 2014 56 Abstract: The coronary-to-pulmonary artery fstulas are usually discovered incidentally during routine cardiac catheterization after the development of atherosclerotic coronary artery disease. We report the incidental fnding of two cases of coronary-to-pulmonary artery fstulas who presented with acute coronary syndrome. Key words: Fistula, Pulmonary Artery, Cardiac Catheterization, Coronary Artery Disease, Acute Coronary Syndrome. Corresponding Author: Dr. Selami Demirelli Email: demirelli23@yahoo.com Received: January 7, 2014 | Accepted: January 24, 2014 | Published Online: February 10, 2014 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (creativecommons.org/licenses/by/3.0) Confict of interest: None declared | Source of funding: Nil | DOI: http://dx.doi.org/10.17659/01.2014.0014 Introduction A coronary artery fstula (CAF) is an abnormal connection between a coronary artery and a cardiac chamber, a great vessel or any other vascular structures. Although most coronary artery anomalies do not cause myocardial ischemia and are diagnosed incidentally, some of these anomalies may cause angina, myocardial infarction or sudden death. We report the two incidental founded cases of coronary-to-pulmonary artery fstulas who presented with acute coronary syndrome. Case Reports Case 1 A 59 year-old man admitted to our emergency unit with complaint of chest pain. The patient’s consciousness suddenly deteriorated and emergency unit staff recognized ventricular fbrillation on the ECG. After emergency defbrillation his ECG had revealed ST segment elevations in DII, DIII and AVF leads confrming the diagnosis of acute inferior MI. After then he was sent to our catheterization unit for further therapeutic evaluation. His cardiovascular risc factors were smoking and hypertension. His blood pressure and heart rate were 100/60 mmHg, 82 bpm, respectively. Physical examination was normal. Transthoracic echocardiography showed inferior and lateral wall hypokinesia of left ventricle, mild mitral regurgitation and mild systolic dysfunction