INTRODUCTION: Congenital coronary arteriovenous fistula is not common (1), since Krause first described coronary arteriovenous flstula in 1865 (2), and Bjork first reported on its surgical treatment in 1947 (3), 300 cases have been reported. Surgical corrections have been documented for fistulous connections between the coronary arteries and the cardiac chambers (1). The majority of the fistulae originate in the coronary artery and terminate on the right side of the heart (right ventricle, right atrium, pulmonary artery, in that order of frequency), and rarely into the left atrium (1). Cases of rarer sites of communication such as peripheral pulmonary arteries have been reported (4), and this occurred with left coronary artery. DISCUSSION: All the three cases described represent a common from of coronary arteriovenous fistula formation into the right side of the heart (mainly the right atrium). Half of the congenital coronary arte ii ovenou s fi stul ae originate from the right coronary artery and 92% of all coronary fistulae enter the right side of the heart (1,5). Cardiac catheterization, aortography and selective coronary arteriography, if feasible, are essential for proper diagnosis of this anomaly. The lattermethod was applied in our three patients and it worked well.

Isolation of the left subclavian artery (LSCA) or its anomalous origin from the pulmonary artery (PA) has been documented in several cases, especially in association with a right-sided aortic arch. Similar anomalies involving the right subclavian artery (RSCA) are less frequent. Anomalous origin of the RSCA from the PA in association with D-transposition of the great arteries (D-TGA) is exceedingly rare and only two cases have been reported so far. We present here, a case of aberrant origin of the RSCA from the right PA in a patient with D-TGA, in whom the diagnosis was rendered difficult due to the partial occlusion of the intervening ductus arteriosus (DA). We discuss the embryological basis of this anomaly and review its clinical and surgical implications.

We report a case of erosion of an aneurysm of the right sinus of Valsalva into the interventricular septum. The mode of presentation, the preoperative evaluation, and the echocardiographic and nuclear magnetic resonance imaging features are presented, and the cardiac catheterization findings and surgical management of this very rare cardiac pathology are discussed.

A case of paradoxical embolus that caused initial ischemic changes on the electrocardiogram monitor and later a massive myocardial infarction and cardiac arrest with death is presented. This occurred during a pulmonary wedge biopsy to determine the operability in a twenty-eight-year-old patient with ventricular septal defect and high pulmonary artery pressure diagnosed by catheterization. Autopsy revealed a long blood clot measuring 6 cm in length and 0.5 cm in width sitting and completely blocking the orifice of the left coronary artery. This caused the coronary insufficiency. A similar clot was found on the tip of the central venous pressure catheter when the right atrium was opened.The causes of and means of preventing this fatal complication in patients with left and right-heart communications are discussed in detail.

Twenty four patients underwent pericardectomy for constrictive pericarditis. There were 2 operative deaths. Tuberculosis was the aetiological factor in 20 patients and a post surgical aetiology was found in 2 patients. The aetiology remained unclear in 2 patients.