Fistulous communication between the left coronary artery and main pulmonary artery: a thirteen-year follow-up.

A patient with a fistula producing a 2:1 left-to-right shunt between the coronary arteries and pulmonary artery followed for 13 years is described. The patient remained asymptomatic and without significant electrocardiographic, hemodynamic, or angiographic changes. Large collateral vessels were demonstrated on initial and repeat angiographic studies. This case illustrates the natural history of coronary artery to pulmonary artery shunts and suggests that surgery may not be necessary, even in the presence of a very large communication.