Natural History Of Ventricular Septal Defect; A Study Involving 790 Cases

Abstract

The first documentation is reported of spontaneous closure of a coronary artery to right ventricle fistula that was demonstrated initially in a 14-month-old boy. A heart murmur was first noted at 2 months of age. At examination, the boy was asymptomatic and his growth and development were normal. At 14 months of age, elective cardiac catheterization and angiography was performed. A small left to right shunt was detected. At 2 and 3 years of age the murmur was still present. Over the 4 year period after diagnosis, the characteristic continuous murmur gradually disappeared. When the patient was 5 1/2 years of age, selective coronary arteriography showed normal coronary vessels and circulation. At subsequent examinations over the next two years, the boy was normal. Six other cases of coronary fistula observed during the past 10 years are also reviewed. This study supports the rationale for clinical follow-up rather than obligatory surgical intervention in asymptomatic patients with a small shunt who have no evidence of myocardial dysfunction. (Permission to reproduce case report denied by author.)