CASE REPORT Spontaneous Closure of a Symptomatic Coronary Artery Fistula Just within a Few Days of Newborn Period Murat Muhtar Yilmazer, MD,* Fikri Demir, MD, ‡ I ˙ lyas Yolbas ¸, MD, † and Meki Bilici, MD* Departments of *Pediatric Cardiology and † Pediatrics, Dicle University Medical Faculty, and ‡ Department of Pediatric Cardiology, Diyarbakır Teaching and Research Hospital, Diyarbakır, Turkey ABSTRACT We present a rare case of spontaneous closure of a fistula between the left coronary artery and the right ventricle (RV) within a few days of newborn period. A 14-day-old male newborn was referred to our clinic for investigation of tachypnea and cardiac murmur. A color flow Doppler echocardiography revealed turbulent flow of a large coronary artery fistula (CAF) between the left coronary artery and the RV. Tachypnea was regressed and repeat echocardiogram showed no CAF related to cardiac chambers after 4 days of admission. The spontaneous closure of CAF was found to be more likely in cases younger than 2 years with small-sized fistulas opening into the right-sided structures, especially into the RV. Nevertheless, the spontaneous closure is very rare in cases with significant shunt. To the best of our knowledge, this is the first case with documented spontaneous closure of CAF just within the newborn period. Key Words. Neonate; Coronary Fistula; Left Coronary Artery; Spontaneous; Regression Introduction C oronary artery fistula (CAF) was defined as a communication between any coronary artery and adjacent cardiac chamber or vascular struc- ture. 1 Despite some acquired cases reported, the vast majority of the cases are congenital. Depend- ing mostly on its diameter, CAF may be asymp- tomatic or present with congestive heart failure, angina, dyspnea on exertion, infective endocardi- tis, and/or aneurysmal rupture. 2,3 Although spon- taneous closure of the CAFs is possible, a considerable proportion of the cases is treated with percutaneous transcatheter interventions or surgery. 4 Previous reports denoted that the closure of CAFs might be observed during follow-up period, 1,4,5 but none of those cases were as young as a few weeks of age. Herein, we report a newborn with CAF that was regressed spontaneously in a few days of life. To our knowledge, this is the first case with CAF that spontaneously closed within the newborn period. Case Presentation A 14-day-old male newborn was referred to our clinic for investigation of tachypnea and cardiac murmur that had been discovered on routine postnatal examination. His medical history was unremarkable. Physical examination revealed mild tachypnea and a continuous murmur at the left lower sternal border. We did not find any abnormal finding in the lung fields. The electro- cardiogram (ECG) (ECG-1350K, Nihon Kohden Corporation, Tokyo, Japan) was normal while the chest roentgenogram showed mild cardiomegaly. Mild right ventricular enlargement and dilated left coronary artery (LCA) with the inner diam- eter of 3.3 mm were determined by two- dimensional echocardiography (Vivid S5, GE Vingmed Ultrasound AS, Horten, Norway). A color flow Doppler echocardiography (Vivid S5) revealed turbulent flow of a large CAF between the left circumflex artery and the right ventricle (RV), together with resultant continuous turbu- lent flow pattern (Figures 1 and 2). The neonate 1 © 2013 Wiley Periodicals, Inc. Congenit Heart Dis. 2013;••:••–••