Surgical repair of triple coronary-pulmonary artery fistulae with associated atrial septal defect and aortic valve regurgitation

Coronary arterio-venous fistulae are congenital or acquired cardiac anomalies whereby blood bypasses the myocardial capillary network. Involvement of all three coronary arteries is rare. There is a wide variation in the clinical presentation and the actual morphological malformations. The mainstay of treatment is either surgical or coil embolisation. Associated congenital malformations can be dealt with during the same surgical setting if required. We present a case of coronary arterio-venous fistula involving all three coronary arteries with associated atrial septal defect and acquired aortic regurgitation, all of which were dealt with surgically with good surgical outcome.