Late complications in traumatic coronary artery fistula: report of a case requiring surgical repair after 8 years.

We report the unusual case of a patient with traumatic coronary artery fistula who had been free of symptoms for more than 4 years, but who ultimately required surgical repair 8 years after the trauma due to late complications including angina pectoris, atrial flutter and fibrillation, congestive heart failure, and tricuspid regurgitation. Our findings suggest that early surgical repair should be undertaken in cases of traumatic coronary artery fistula, even if the shunt is minimal and early symptoms are mild. The persistence of, or a slow increase in, shunt flow over the years greatly increases the risk of the ultimate development of life-threatening complications.