[Congenital arteriovenous fistula of the coronary arteries in adults: 12 personal cases, a review of the literature, discussion of treatment possibilities].

Between 1976 and 1988, we found in a series of 18,000 coronary angiographies, 12 cases with 15 arteriovenous fistulas of the coronary vessels (incidence of 0.7%). Clinical symptoms were atypical angina pectoris and dyspnea upon exertion. Three patients had a systolic-diastolic murmur. In six cases we found fistulas accidentally, in concurrence with another important cardiovascular disease; 10 fistulas were singular, two fistulas were bilateral. The course was in 10 cases to the pulmonary artery, in three cases to the right atrium, in one case to the right ventricle, and in one case to the superior vena cava. With the exception of one patient, shunt volume was minimal. There were two preoperative sudden deaths of patients with extended fistulas and supra-ventricular arrhythmias. Complications and delineations of management are discussed.