[A rare cause of a continuous murmur. Our experience with a newborn infant with a congenital coronary fistula].

Congenital coronary artery fistulas are very rare. The most common connect one of the two coronary arteries with the right cardiac chambers, in particular the right ventricle. So, a left to right shunt appears; furthermore ischemic problems are possible. Notwithstanding in the pediatric age subset the patients are usually free of symptoms. The most important clinical sign is a continuous murmur in the precordium. We report a case of a newborn with a fistula between the right coronary artery and the right ventricle. He presented with the typical murmur; ECG and chest-ray were considered as normal. Echocardiography did not do the diagnosis, and the baby was submitted to a cardiac catheterization. There was a mild left to right shunt (QP/QS = 1.5/1), without pulmonary hypertension. The diagnosis was done by selective coronary angiography. We decided not to close the fistula, and the baby was discharged. Three months later he is still well. In this discussion we consider indications for surgery, and hypothesize a wider application in the future of transcutaneous embolization.