A sixty-seven-year-old woman with effort intolerance and presyncope was noted to have a congenital aneurysmal right coronary artery to left ventricular fistula, an ostium secundum atrial septal defect, and severe aortic insufficiency. This is the first case reported with this combination of cardiac anomalies. The diagnosis was confirmed by cardiac catheterization, coronary angiography, and aortography. Aortic valve replace ment, closure of the atrial septal defect, and ligation of the right coronary artery to left ventricle fistula were performed without incident. The patient has remained asympto matic since surgery.
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