Asymptomatic continuous murmur due to acquired coronary artery to right ventricular fistula.

An unusual case of an acquired coronary artery to right ventricular fistula is reported. A new continuous murmur was noted one month following a puncture wound to the precordium. Cardiac catheterization documented a left anterior descending coronary artery to right ventricular communication with a small left to right shunt and normal cardiac pressures. The angiographic appearance was that of a false aneurysm of the anterior descending artery with rupture into the right ventricle. The patient has been followed for 36 months and is asymptomatic with no evidence of myocardial ischemia or infarction. Because of the small size of the fistula and its intracardiac position, conservative treatment has been employed.