RESUMEN
A coronary artery fistula usually originates in the right coronary artery and often opens into the right ventricle. In approximately 50% of cases with a main pulmonary artery opening, aberrant blood vessels originate from both coronary arteries. Only a few cases of both coronary and bronchial artery-pulmonary artery fistulas have been reported. The patient was an 83-year-old man. Echocardiography showed severe aortic stenosis, while coronary angiography revealed aberrant vessels from both coronary arteries to the pulmonary artery. The right heart catheterization revealed a 26% left-to-right shunt ratio and a pulmonary/body blood flow ratio (Qp/Qs) of 1.36. MDCT scan confirmed that the aberrant vascular plexus originating from both coronary arteries was connected to the bronchial artery. We performed surgery on the patient, replacing the aortic valve and resecting the coronary arteriovenous fistulas. On the 11th postoperative day, the shunt had disappeared, as evidenced by a 1.2% left-toright shunt ratio and a Qp/Qs of the right heart catheterization of 1.02. The patient progressed uneventfully and was discharged on the 25th postoperative day.