[Bicoronary-pulmonary fistula with aneurysms of the left coronary artery].

Bicoronary-pulmonary fistulae are extremely rare cardiac malformations with only ten cases reported. We describe the case of a 46-year-old woman who was referred to our hospital because of a continuum of subfebrile temperature between 37 and 39 degrees C. On chest X-ray there were no signs of right ventricular volume overload or pulmonary congestion, the electrocardiogram showed no abnormalities. Auscultation revealed a 3/6 systolic-diastolic murmur with maximal intensity in the second and third intercostal space at the left parasternal border. At catheterization a coronary-pulmonary fistula of the left coronary artery at the end of the proximal third of the anterior descending branch with an aneurysm of the left main coronary artery and the proximal part of the anterior descending artery was found. Additionally an abnormal conal branch of the right coronary artery was found draining into a venous convolute around the pulmonary artery stem. A left-to-right shunt of 15 percent was calculated. To our knowledge this is the first case report of such a combination of a bicoronary-pulmonary fistula.