Traumatic left anterior descending coronary artery to right ventricle fistula: report of two cases.

Two cases of traumatic fistulas between the left anterior descending coronary artery and right ventricular outflow tract are presented. One was due to a stab wound and the other to blunt chest trauma. Both patients had small left-to-right shunts. The first patient had surgical closure of the fistula, but it recurred postoperatively. His murmur subsequently disappeared spontaneously four months later. The second patient is being treated medically. Based upon review of the available data, we believe that surgical therapy should be individualized, that asymptomatic individuals with small shunts may be treated conservatively, and that this entity may be more common than previously thought.