Antegrade flow in the ascending aorta despite aortic atresia: a propos of two cases with retrograde coronary perfusion through sinosuids and fistulas

In aortic atresia, coronary perfusion normally occurs through retrograde bl ood flow in the ascending aorta. We report on two patients with antegrade f low in the ascending aorta despite aortic atresia. In one patient with hypo plastic left heart syndrome (aortic atresia, severe mitral stenosis), an in tact interatrial septum/premature closure of the foramen ovale was found. W hile no other way of left atrial or ventricular decompression was found, ec hocardiography, angiography and the post-mortem examination showed left ven tricular to coronary sinusoids as the sole pathway for systemic oxygenation . In a second patient with complex congenital heart disease, including aort ic atresia, antegrade flow in the ascending aorta was through a left corona ry fistula with shunt flow originating from the pulmonary trunc. This report describes systemic perfusion depending on retrograde coronary f low due to coronary-cameral (sinusoids) and coronary arterio-venous fistula s leading to the phenomenon of antegrade blood flow in the ascending aorta despite aortic atresia.