CORONARY-ARTERY FISTULAS WITHOUT AUDIBLE MURMUR IN ADULTS

Retrospective analysis of 4886 adults undergoing coronary arteriograph y for evaluation of angina between October 1988 and December 1991, rev ealed coronary artery fistulae in eight patients (all men, aged 36-69 years). No murmur was audible in any of these eight patients. Associat ed significant coronary artery disease was detected in five patients. The feeder arteries to the fistula were both the left main coronary ar tery and the left anterior desending artery (LAD) in two, the LAD in s ix, and the right coronary artery in two patients. The fistula termina ted in the pulmonary artery in seven patients and in the right atrium in one patient. Successful operative treatment (coronary artery bypass grafting and ligation of the fistula) was undertaken in four patients with severe obstructive coronary artery disease with satisfactory res ults. Follow-up for up to 2 years of the three patients with coronary artery fistula and no associated coronary artery disease who did not u ndergo surgery revealed continuing good prognosis. We conclude that co ronary artery fistula in adults is a distinct, though rare (incidence in present series 0.11%) entity, without audible murmur, commonly asso ciated with coronary artery obstructive disease, and that the diagnosi s is mostly incidental during routine coronary arteriography.