Diagnosis of a coronary artery fistula thirty years after myectomy for septal hypertrophy

A 61-year-old asymptomatic male patient was evaluated before abdominal surg ery. He has a history of septal myectomy in 1969 and an episode of atrial f lutter in 1983. On auscultation an atypical murmur was heard. By transthoracic echocardiogr aphy the diagnosis was made of a coronary artery fistula after septal myect omy. We discuss the prevalence, diagnosis and natural history of coronary artery fistulas. In our patient we followed a conservative strategy.