Discussion:
Isolated CAF is a rare congenital cardiac defect accounting for only
0.2-0.4% of all CHD (1, 3). Coronary artery fistulas involving the
right heart structures are more common than those involving the left
heart structures. Asymptomatic patients with CAF (nearly 80%) are
diagnosed after routine examination revealing a cardiac murmur (3, 11,
12) as was the case of our patient. Some authors tend to leave CAF
untreated in children considering the low morbidity and mortality in
this group of patients and the possibility of spontaneous closure (3,
12, 13). On the other hand however; other authors recommend early
closure of CAFs even when asymptomatic to avoid severe complications
that may develop such as CHF, infective endocarditis, myocardial
infarction, aneurysm formation, rupture, ventricular arrhythmia and
sudden death (3, 13).