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The Journal of Thoracic and Cardiovascular Surgery, Vol 74, 199-203, Copyright © 1977 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association

ARTICLES

Surgical closure of left coronary artery-left ventricular fistula: the second case reported in the literature and a review of the five previously reported cases of coronary artery fistula terminating in the left ventricle

AI Midell, GA Bermudez and R Replogle

Surgical closure of a left coronary artery-left ventricular fistula in a 44-year-old black man is reported. The fistula was discovered by coronary arteriography after the patient was admitted to the hospital complaining of recurrent chest pain. The fistula was closed with cardiopulmonary bypass, ischemic arrest, and hypothermia, and there was an uneventful postoperative recovery. The previously reported five cases of fistulas terminating in the left ventricle that were closed surgically are reviewed. Four of these cases originated in the right coronary artery and one in the left coronary artery. Three of the six patients were symptomatic at the time of discovery of the lesion. Cardiopulmonary bypass was necessary in five of the six cases. One patient died in the postoperative period from intractable hemorrhage. It is recommended that coronary artery fistulas by closed upon establishment of the diagnosis because of the sequelae if they are allowed to remain open; these include premature atherosclerosis, aneurysmal dilatation of the coronary artery, and congestive heart failure.

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				Kwang Kon Koh, Sang Kyoon Cho, and Sam Soo Kim Left and Right Coronary Artery to Left Ventricular Fistula: Demonstration of Myocardial Ischemia by Treadmill Test and Holter Monitoring--A Case Report Angiology, December 1, 1993; 44(12): 977 - 980. [Abstract] [PDF]

				C. O. Urrutia-S., G. Falaschi, D. A. Ott, and D. A. Cooley Surgical Management of 56 Patients with Congenital Coronary Artery Fistulas Ann. Thorac. Surg., March 1, 1983; 35(3): 300 - 307. [Abstract] [PDF]

				A. I. Midell and G. A. Bermudez Left-Coronary-Artery to Left-Ventricle Fistula JAMA, November 3, 1978; 240(19): 2045 - 2045. [Abstract] [PDF]