Abstract
Congenital fistula in the coronary artery was first reported in 1865 by Krause. Since then, this disease was regarded as a comparatively rare disease. As a result of recent popularization of the use of selective coronary angiography, the number of reported cases of this disease has been increasing. Of these, however, the coronary artery fistula to left ventricle is still rare, and it is reported that the incidence of this type of fistula makes up only ago of all coronary artery fistulas. In Japan, only about 30 cases have been reported so far.
The symptoms of the disease included the ones related to shunt between right and left ventricles, those of cardiac ischemia and bacterial endocarditis if it is complicated. However, some cases are asymptomatic. In many cases, the disease is found by the presence of continuous heart murmur. Final diagnosis is made by coronary angiography, but tomographic echocardiogram is also helpful in differentiating this disease from other diseases.
We report a case of a 49-year-old female. She had angina-like pain. An electrocardiogram showed an ischemic change, so she underwent detailed examinations of the heart. Systolic murmur of samuel-Levine grade 1/6 and decrescendo distolic murmur were audible. Meanwhile, two-dimensional echocardiograms showed an expansion and calcification of the orifice of the right coronary artery. Besides, it was found by coronary angiography that the right coronary artery was flowing into the left ventricle. According to the standards for surgical indication set by Konno et al, this patient should undergo operation as the electrocardiogram showed an ischemic change. However, the left ventricular overload was not remarkable, and no aneurysmal formation was observed. Therefore, the patient has been followed up medically.
