Abstract
persistence of intertrabecular spaces of the embryonic myocardium, with failure of obliteration of these spaces by compression from the surrounding developing myocardium.5s6 A developmental arrest at an early stage may thus result in multiple communications. The possible role of the thebesian system of veins has been alluded to in cases of CACF draining into the left ventricle,2,5.9 but has not been invoked as a mechanism in reported cases of fistulas draining to the right ventricle. The nature of the fistulous communication described in this case, would seem to indicate that a developmental arrest was involved in the pathogenesis of the CACF. The case described above demonstrates the unusual occurrence of multiple fistulas from RCA to the right ventricle, with filling of the mid and distal RCA from the left anterior descending artery. In addition, a hitherto undescribed surgical appraoch to the management of CACF is reported, whereby a physiologic cure was obtained with no adverse effects.
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