[Hemodynamic mechanisms of ECG changes in congenital fistulas of the coronary arteries].

ECG changes were analysed in 31 patients with congenital coronary arterial fistulas with reference to the site of coronary arterial lesion and the level and magnitude of blood discharge. Two hemodynamic factors, conditioning ECG changes, were identified as typical for coronary arterial fistulas: 1) volume strain on cardiac compartments making up the fistula receptacle chamber; 2) perfusion deficiency in the distal segment of the affected coronary artery. Fistulas with large-volume shunts may be accompanied by both ischemic changes in the affected-artery basin and regional perfusion disorders in adjacent basins, the latter being due to "stealing" of the adjoining coronary trunk or the type of coronary blood supply.