CLINICAL IMPLICATIONS OF CORONARY PULMONA RY-ARTERY FISTULAS

Coronary artery fistulas are the most common forms of congenital coron ary anomalies. They are precapillary communications between one or mor e coronary artery(ies) and a cardiac chamber or a great vessel of the central circulation. The potential of these major forms of coronary an omalies is the impairment of myocardial perfusion by a coronary steal phenomenon. Most probably, a coronary fistula can reduce myocardial pe rfusion in cases of associated obstructive coronary artery disease. Ho wever, there are also cases without coronary obstruction reported in t he literature where myocardial ischemia or even infarction was present . Only few information is available about induction of ischemia in pat ients with congenital coronary fistula, although this is of major impo rtance for the individual therapeutic approach. The indication and the timing of surgical therapy are still discussed controversially. The p resent description of three cases with bilateral and one case with uni lateral coronary arteriovenous fistulas to the pulmonary trunc emphasi zes the fact of ischemia induction as a guide to therapeutic managemen t.