Bilateral Coronary Artery-Pulmonary Artery Fistulas

CORONARY ARTERY FISTULAS, precapillary communications between a coronary artery and a cardiac chamber or vessel, have been described as the most common hemodynamically significant congenital coronary anomaly.' In a review of 21 original cases and 342 previous cases, Levin et al.' reported that coronary fistulas originated slightly more often from the right than from the left coronary artery, but that bilateral fistulas those that originate from both coronary arteries accounted for only 5% (19 of 363) of the total. These bilateral fistulas are unique in their tendency to terminate in the pulmonary artery. More than half of the bilateral, but only 17% of the unilateral fistulas, terminated in this manner. In this report, we review the nine previously described cases of bilateral coronary artery-pulmonary artery fistulas and present five additional cases studied at our institutions between December 1976 and March 1981. The anatomic uniqueness of these fistulas and some considerations in their management are discussed.