Coronary Artery-Atrioventricular Fistula and Ventricular Septal Defect due to Penetrating Wound of the Heart

Abstract

A patient with an unusual combination of lesions secondary to gunshot wound of the heart is presented. The predominant abnormality was a large fistula between the right coronary artery and the floor of the right atrium. The right coronary also communicated with the cavity of the right ventricle, and there was an associated posttraumatic ventricular septal defect. The presence of an arteriovenous fistula was suspected, based on the presence of a continuous precordial murmur. This diagnosis was confirmed by arteriography. Findings at surgery and the technic of repair are illustrated. Reference is made to three other patients with traumatic communication between the coronary artery and the atrium. Attention is directed to coronary artery atrio-ventricular fistula as another anatomic type of deformity to consider in patients with penetrating wounds of the heart. The probable recurrence of the fistula 3 weeks after what appeared to be a successful repair illustrates one of the problems to consider in evaluating such patients for surgery.