Congenital coronary artery fistulae

Abstract

Congenital coronary artery fistula is an uncommon cardiac anomaly involving an abnormal communication between one or both coronary arteries and any chamber of heart. The right coronary artery is involved most frequently, and the abnormal communication is most commonly with the right atrium or right ventricle. Although cardiac catheterization and angiography are required for definitive diagnosis, the lesion can be suspected clinically in any patient with a continuous murmur suggestive of a patent ductus arteriosus, especially if the murmur is abnormally located, and particularly if there is associated clinical evidence of right sided cardiac enlargement. Although patients are usually asymptomatic, congestive heart failure, angina pectoris and bacterial endocarditis occasionally may be present. Definitive treatment is surgical closure of the fistulous communication.