Congenital Coronary Arteriovenous Fistula

SEVERAL excellent reviews have been published recently describing the anatomic and clinical findings in patients with congenital coronary arteriovenous fistulas or with communications between the coronary arteries and the cardiac chambers.1-3 The recognition of this clinical entity presents real difficulty, since it may easily be confused with other lesions causing a continuous or to-and-fro murmur, such as patent ductus arteriosus, aortopulmonary septal defect, ruptured aneurysm of an aortic sinus, interventricular septal defect with aortic insufficiency, and arteriovenous communications within the chest wall or lungs. In some instances only a systolic murmur has been recognized. For this reason both cardiac catheterization and angiocardiography are usually required for accurate diagnosis. Of the diagnostic measures available retrograde aortography affords the best opportunity for an accurate diagnosis. We have collected 38 cases from the literature. The first case from Steinberg 's paper was discarded, since the patient had an anomalous coronary artery arising from the pulmonary artery. Although functionally similar in some respects, cases with anomalous origin of coronary arteries are best placed in a separate category. The true figure may be higher, since, as Steinberg pointed out, some coronary artery aneurysms that were considered primary lesions may have resulted from arteriovenous fistulas that were not detected at autopsy.3