In the course of the disease, up to 50% of patients develop intestinal complications such as fistulas and abscesses (16).
A residual fistula was found between the left coronary artery and the right ventricle.
All showed features suggestive of coronary arterial fistulas as evidenced by abnormal flow at high velocity into the recipient chamber or vessel.
This patient had a massive coronary-cameral fistula, another example of a coronary circulation that is right ventricular-dependent.
In contrast to the multiplanar technique, angiography hardly opacified the fistulas, presumably due to high flow of blood within the fistulas.
This is excacerbated by the intense postoperative catabolic state and the huge loss of proteins and immunoglobulins through the fistula.
Of cases in the literature, about one-twentieth have bilateral fistulas, which is consistent with our series.
In the 4 patients in whom contrast echocardiography showed no early left atrial contrast, invasive investigation failed to reveal fistulas.
