IN LOCAL experience coronary arteriovenous fistula or aortic sinus of Valsalva aneurysm rupture into the right side of the heart are the two common causes of continuous murmurs with systolic accentuation which are maximum over the lower sternum. This report describes three patients with coronary arteriovenous fistula who had successful surgical repair and five patients with anatomically verified aortic sinus aneurysm rupture, two of whom had successful repair.
Coronary Arteriovenous Fistula.
—Two patients were 20-year-old women. The third was a 24-year-old man. Two had increased arterial pulse pressure and heart failure, and each had cardiac enlargement. The dilated right coronary artery was demonstrated by aortography to communicate with the right ventricle in each instance. Surgical correction was followed by disappearance of the murmur and decrease in heart size.
Aortic Sinus Aneurysm Rupture Into the Right Side of the Heart.
—Each of the five patients demonstrated increased arterial pulse