COMBINATION OF CORONARO-PULMONARY FISTULA AND INTERCORONARY FISTULA -A CASE-REPORT

The authors present the case of a 30-year-old woman admitted to hospit al for investigation of a systolodiastolic murmur. Assessment revealed a fistula between the trunk of the left coronary artery and the pulmo nary artery, with an aneurysm on the left anterior descending artery ( LAD), associated with an intercoronary anastomosis between the left co nus artery and the LAD. Thallium myocardial scintigraphy demonstrated reversible decreased uptake in the anterolateroapical region. Simple c oronaro-pulmonary fistulas are a rare disease. The positive diagnosis is suggested by echocardiography and confirmed by coronary angiography . The clinical course is generally favourable, except in the presence of complications such as aneurysm, heart failure or coronary insuffici ency. This case raises the difficult problem of the operative indicati on in these young, usually asymptomatic patients.