[Traumatic coronary-cardiac fistulas. Apropos of a case]

The case of a 24-year old patient having suffered a bullet wound was reported. After a hemopericardium accompanied by minor signs of tamponade, a continuous murmur gradually appeared due to a fistula between the right coronary artery and the right atrium, which was strictly symptomless: surgical repair was performed eight years after the accident. This satisfactory spontaneous outcome, after surviving the life threatening danger of tamponade and myocardial infarction was also observed in the 21 cases of coronary-cardiac fistulae already published. The fistula, which almost always involves the right heart cavities, only gives rise to a continuous murmur which is often discovered at a later stage. The long term course of traumatic coronary-cardiac fistulae can only be assessed by comparison with congenital coronary-cardiac fistulae, which are much better known, and the consequences of which are on all accounts similar. Four complications are discussed: heart failure, coronary insufficiency, infectious endocarditis, and the rupture of the fistulized coronary artery due to aneurysmal dilatation. These risks are statistically small and more theoretical then real, and the justification of systematic repair of traumatic coronary-cardiac fistulae now rests essentially on the relatively low risk of the procedure.