CLINICAL AND ANGIOGRAPHIC ANALYSIS OF CONGENITAL CORONARY-ARTERY FISTULAS IN ADULTHOOD - IS THERE ANY NEW TREND

Fifteen (2.1%) patients were diagnosed as having congenital coronary a rtery fistula (CAF) in a consecutive series of 704 adult patients unde rgoing selective coronary arteriography; the incidence was astonishing ly higher than previous observations. The presentation of clinical sym ptoms and the electrocardiographic changes at rest and/or after exerci se testing probably attributable to the CAF were observed unexpectedly often in spite of the fact that the magnitude of the shunt seemed not to be significant. With respect to the anatomy of the CAF, the incide nce of origination from plural coronary arteries and that of fistulati on into the left ventricle were also unexpectedly high. These observat ions presented a striking contrast to those of previous reports, but w e were unable to determine the reason. In four cases, the CAF was liga ted either electively or concurrently with mitral valve surgery, and t he results were satisfactory. Taking these circumstances into consider ation, we should not minimize the impact of a CAF with a seemingly sma ll shunt.