Multiple Coronary

SUMMARY A 62-year-old man who died suddenly was found at autopsy to have multiple coronary arteriosystemic fistulae involving all three major coronary arteries and both ventricles. This is the second such case reported and the first with biventricular involvement and autopsy findings. A congenital bicuspid valve was also present. Numerous small blood vessels opened onto the endocardial surface of both ventricles and there were microscopic foci of persistent embryonic spongy myocardium. A CORONARY ARTERY communicating with a cardiac chamber or the pulmonary trunk may cause a continuous murmur. Most patients with this condition are symptomless, but the fistula may lead to con-gestive heart failure, infective endocarditis or myo-cardial ischemia. The condition is usually congenital, but has been reported after myocardial infarction.' The congenital form is not rare and in most instances a single fistula is present. However, congenital coronary fistulae com