Disappearance of coronary artery-ventricular fistulas after a radical operation for tetralogy of fallot

A 42-year-old Japanese man was diagnosed as tetralogy of Fallot (TOF). Coronary arteriography demonstrated coronary artery-ventricular fistulas (left coronary artery to left ventricle, right coronary artery to right ventricle). A radical operation for TOF was performed, including a patch closure of the ventricular septal defect, right ventricular muscle resection and a patch enlargement of the right ventricular outflow tract. After the operation, coronary arteriography showed a marked decreased in the shunt flow through the coronary artery-ventricular fistulas. Six months later, the patient was diagnosed as postoperative constrictive pericarditis, while the fistulas had almost completely disappeared, the fistulas did not reappear. This is the first report of TOF complicated with multiple coronary artery- ventricular fistulas which completely disappeared after a radical operation. It is conceivable that in our case coronary artery-ventricular fistulas partially compensated for reduced arterial O₂ saturation and disappeared after surgical correction with an improvement in hemodynamic variables.