Left circumflex coronary artery to coronary sinus fistula diagnosed in infancy

Coronary artery fistulas are rare anomalies, their incidence range from 0.1 to 0.2% of congenital heart defects. The left circumflex coronary artery (LCX) fistula draining into the coronary sinus (CS) is a less common form, and most cases described in the literature were adult cases. We are describing this type of fistula in an 8-month-old asymptomatic female presenting with a continuous murmur over the pericordium. Electrocardiogram was normal. Echocardiography revealed a dilated LCX and CS with turbulent flow in CS; 2-D speckle tracking echocardiography revealed normal left ventricular strain with no regional wall abnormalities. Multidetector computed tomography demonstrated the fistula. As the patient was asymptomatic, with no ventricular dilatation or dysfunction, we decided conservatively. <Learning objective: Coronary artery fistulas are rare anomalies that require complementary diagnostic modalities. 2D echocardiography, color flow Doppler, 2D speckle tracking, and multidetector computed tomography are needed to delineate the anomaly and to conclude the prognosis and long-term follow-up plans.>.