Acquired coronary-to-bronchial artery fistula after two valve surgeries

A 62-year-old woman with Takayasu arteritis and 2 prior aortic valve replacements, was admitted with unstable angina. Computed tomographic angiography showed a newly developed right coronary artery-to-right bronchial artery fistula. Because of dense aortic calcification, catheter embolization was undertaken, which was successful. We believe the acquired coronary artery fistula developed after her uneventful second aortic valve surgery, due to inevitable trauma to the mediastinum and ascending aorta, and partly due to her underlying Takayasu arteritis.