ANEURYSMAL RIGHT CORONARY-ARTERY TO LEFT-VENTRICLE FISTULA ASSOCIATEDWITH ATRIAL SEPTAL-DEFECT AND AORTIC-INSUFFICIENCY - SURGICAL CONSIDERATIONS

A sixty-seven-year-old woman with effort intolerance and presyncope wa s noted to have a congenital aneurysmal right coronary artery to left ventricular fistula, an ostium secundum atrial septal defect, and seve re aortic insufficiency. This is the first case reported with this com bination of cardiac anomalies. The diagnosis was confirmed by cardiac catheterization, coronary angiography, and aortography. Aortic valve r eplacement, closure of the atrial septal defect, and ligation of the r ight coronary artery to left ventricle fistula were performed without incident. The patient has remained asymptomatic since surgery.