Coronary arterial fistulas: Seven cases with unusual features

Abstract Seven patients with a coronary arterial fistula with unusual features are reported. Two patients had unusual anatomy of the coronary arteries, 1 with a single left coronary artery terminating in a fistula to the right ventricle, and 1 with a rudimentary left coronary artery terminating in a fistula to the pulmonary artery (simulating anomalous coronary artery from the pulmonary artery). One fistula was due to nonpenetrating chest trauma, and 1 was associated with tetralogy of Fallot. The usual continuous murmur was not present in 1 patient. In 2 patients mitral insufficiency developed: 1 had a holosystolic murmur and 1 a mid-systolic click and late systolic murmur. In 2 children there was electrocardiographic evidence of myocardial infarction. Left ventricular end-diastolic pressure levels were elevated in 3 patients. The continuous murmur in 1 patient spontaneously disappeared.