Coronary artery microfistulae, Thebesian veins, or vessels of Wearn?

Abstract

We present the case of a 73-year-old woman with coronary artery-left ventricular multiple microfistulae, who was admitted with symptoms and ECG suggestive of coronary artery disease. Coronary angiography revealed tortuous coronary arteries with multiple microfistulae between the left coronary artery and the left ventricle, as well as between the right coronary artery and the left ventricle. Transthoracic echocardiography (TTE) was also able to clearly demonstrate the presence of the microfistulae with their direction of blood flow towards the left ventricle. Despite traditional reliance on coronary angiography, this case advocates for the diagnostic role of TTE due to its non-invasive nature and ability to provide crucial preliminary information, even in cases with such small structures as these microfistulae. We emphasize the importance of precise, modern terminology over historical eponyms such as Thebesian veins or vessels of Wearn, aligning medical communication with contemporary diagnostic capabilities.