[Congenital fistulas of the coronary arteries. A review with case presentations].

Coronary artery fistulas are rare atypical communications between a coronary artery and a cardiac chamber or other great vascular structure and usually congenital in origin. Many are detected accidentally by the use of coronary angiography. These fistulas often have minor hemodynamical significance and the course is primarily from the proximal left coronary artery to the pulmonary artery. Though symptoms are rare they should be observed carefully in aspect of possible complications. In contrast sometimes coronary artery fistulas are found when searching for the cause of cardiac murmurs or clinical symptoms. Great amounts of shunted blood can result in cardiac volume overload and myocardial ischemia may occur by coronary steal. Surgical closure of these fistulas is the treatment of choice. In our laboratory we found in a series of 3,000 coronary angiographies a 53 year old man with an abnormal communication from the right coronary artery to the right atrium and a 68 year old woman with a fistula from the proximal left anterior descending artery to the pulmonary artery.