No abstract

physical findings established the diagnosis of a coronary arteriovenous aneurysm in a 6-year-old asymptomatic schoolgirl. During the 7 years that have ensued, her heart size, electrocardiogram, and general condition have remained normal. Review of the literature discloses 13 autopsy-proved coronary artery fistulas and 8 cases wherein the diagnosis was established by exploratory thoracotomy or cardiac catheterization. The data indicate a wide variation in the clinical significance of the lesion and lead to the conclusion that management is best established on an individual basis. CASE REPORTA 6-year-old schoolgirl was referred for consultation in May 1949 because of a heart murmur first heard a year previously. The medical history indicated that her birth followed a normal pregnancy and that physical development and functional capacity had been normal. Under medical observation she has continued to develop normally to her present age of 13 years. She has always been an energetic child, participating in all ordinary childhood activities save for highly competitive sports.On physical examination, abnormal findings, were limited to the heart and have shown no significant change during the 7-year period of observation. The pulse and apex beat were normal. A thrill was not detected. The intensity of the heart sounds was unremarkable. Normal duplication of the second sound in the pulmonary area was observed with the patient in the supine position. A striking cardiac murmur was present. This murmur was loudest in the left fourth and fifth interspaces at the midclavicular line, less intense at the left sternal border, and faintly audible at the angle of the left scapula. It was not transmitted into the axilla. A peculiar superficial quality was noted by all observers. The murmur, moderately high pitched and hollow in quality, began late in systole while its greatest intensity occurred during early diastole, throughout which phase it was continuous ( fig. 1)

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