[Coronary-left ventricular fistulae].

The authors report a case of fistulae between the right and left coronary arteries and the left ventricle. A 58 year old man was investigated for inaugural unstable angina without infarction. Coronary angiography showed multiple communications between the terminal branches of the septal arteries of the left anterior descending, the terminal segments of the left diagonal and the terminal portion of the right coronary artery and the apical region of the left ventricle. Angiography in the ascending aorta confirmed the diagnosis of coronary-left ventricular fistulae. The dilatation and rapid emptying of the entire coronary circulation were indirect signs of increased flow due to the shunt. There was no coronary alternation or stenosis. The rarity of coronaro-cardiac fistulae, especially involving both main coronary arteries and the left ventricle, is emphasised. The symptoms of angina are explained by the coronary "steal" syndrome : the diagnosis is angiographic; rare cases with high flow and a favourable anatomical set up may be managed surgically.