The diagnosis of patent ductus arteriosus is usually easily made. However, aortopulmonary septal defects, coronary arteriovenous aneurysms, ventricular septal defects with aortic regurgitation, and ruptures of the sinus of Valsalva into the right ventricle or pulmonary artery may be responsible for the continuous murmur at the second left interspace. The surgical management of a rare combination of anomalous venous-like communications of the coronary arteries is described and the subject briefly reviewed. Report of Case A 30-year-old white woman began to have dyspnea and palpitation on mild effort and edema of hands and feet during her third pregnancy, four years prior to present admission. After an uneventful delivery she continued to have easy fatigability and developed spells of light-headedness, blurred vision, and numbness in the left arm with a peculiar heavy feeling in the chest. Physical examination revealed her to be in good general condition, with no pallor, cyanosis, or clubbing.