[Late myocardial infarction after closure of coronary artery fistula]. / Infarctus myocardique tardif après fermeture d'une fistule coronaro-cardiaque.

ABSTRACT

Congenital coronary cardiac fistulae are rare conditions for which surgery is the usual indication. The authors report on the case of one female patient of 28 years with a coronary cardiac fistula responsible for exertional dyspnoea and relapsing pulmonary infections. The diagnosis was suggested by a continuous murmur and was confirmed by Doppler echocardiography and catheterization which showed a dilated, sinuous circumflex artery (2 cm) leading into the right atrium. Surgical closure of the fistula was complicated by an early myocardial infarction and a relapse in the same area with resulting mitral insufficiency. The surgical treatment of coronary cardiac fistulae is widely documented in the literature and recent series demonstrate that good results are usually obtained however, a late infarction has not been described. The constitution of thrombi in the collateral vessels deriving from the distended vessel probably accounts for the particular evolution noted in this specific case.