Right coronary-left ventricular fistula mimicking aortic valve insufficiency in infancy.

Two infants had large communications between the right coronary artery just distal to its origin and the cavity of the left ventricle. The findings were essentially those of aortic insufficiency. In the first patient operation was delayed until there was secondary aortic insufficiency resulting from dilatation of the aortic root. The second patient was operated upon in infancy, and abolition of the fistula has relieved the clinical situation. Surgeons should recognize that isolated congenital aortic valve insufficiency has not been reported to our knowledge. Therefore, infants who appear to have this condition should undergo thorough angiographic studies which likely will reveal a remediable situation. A surgical approach for the type of fistula described herein is presented.