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).