Coronary artery to left atrial fistula in association with severe atherosclerosis and mitral stenosis: report of surgical repair.

Not uncommonly, atherosclerosis may be found associated with rheumatic heart disease. The combination of atherosclerosis, rheumatic heart disease and coronary fistula is an unusual combination of hemodynamic and disease states. We report a patient with advanced mitral stenosis and atherosclerosis who also had a fistula from the left coronary artery into the left atrium. Surgical approach: combined valve replacement, bypass grafting and closure of the fistula in an attempt to relieve the pathophysiologic abnormalities.