Single Left Coronary Artery with Fistula to Right Ventricle

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Abstract
The case of an 8-year-old girl with a single coronary artery is presented. This vessel arose as a left coronary artery and followed the distribution of one coronary artery. The long circumflex branch traveled in the atrioventricular groove and continued as a vessel occupying the position usually held by the right coronary artery. It ended as a fistula to the outflow tract of the right ventricle. A continuous murmur was present clinically. Cardiac catheterization and selective angiocardiography demonstrated the anatomy of the lesion and the presence of a left-to-right shunt. Operation consisted of ligation of the fistula and anastomosis of the right ventricular portion of the coronary artery to the aorta with a Dacron tube graft. This latter maneuver established a dual inflow into the coronary arterial system and should overcome the disadvantage of a single coronary artery in the event that arteriosclerotic occlusive lesions develop in later life. Furthermore, the procedure demonstrated the feasibility of grafting technics that may find application in the treatment of anomalous origin of a coronary artery from the pulmonary artery.