[Left coronaro-ventricular microfistulas. Apropos of 25 cases].

A retrospective study of 25 patients with left coronaroventricular microfistulae, investigated in the same vascular radiologic exploration unit, and data in the international literature were used to analyze these lesions in greater detail. Their frequency appears to have been underestimated since they represented 1.33% of coronarographies performed in adults in this series. Distribution into two groups as a function of presence or absence of significant coronary lesions, vascular disease or myocardial insufficiency showed that the group with isolated microfistulae was composed solely of women of about 50 years of age (16 cases). These patients presented typical angina with a simple course (absence of infarction), but a sometimes severe disability due to the symptomatology. The myocardial ischemia could result from a "coronary steal" phenomenon but other hypotheses have been evoked. Their congenital origin is widely accepted but their relation to atherosclerosis has not been established (cause, consequence or fortuitous association). They present specific images on routine coronarography. Treatment is symptomatic but surgical in exceptional cases with refractory, very disabling angina. Finally, detection of left coronaroventricular microfistulae should, when combined with metabolic studies, allow classification of the difficult problem of "angina with angiographically normal coronary arteries".