[Asymptomatic coronaro-cardiac fistula. Apropos of a case]

The case of a 20 year old woman with a right coronary-right atrial fistula is reported. The diagnosis was made during investigation of a continuous murmur and the tolerance was excellent. Aortic root angiography demonstrated a fistula between the initial part of the right coronary artery and a right heart cavity. Selective coronary angiography visualised pseudo-aneurysmal dilatation of the first segment of the right coronary artery, the calibre and trajectory of which was then normal. The medical literature suggests surgical correction even in asymptomatic cases because of the risk of spontaneous complications (cardiac failure 15 p. 100, endocarditis 7 p. 100, infection 4 p. 100). Since 1968, there has been no operative mortality in 145 subjects with isolated coronaro-cardiac fistulae without cardiac failure. In the case presented, the fistula was successfully closed under cardiopulmonary bypass and endoaneurysmorrhaphy was performed to remodel the lumen of the right coronary artery.