Coronary artery-right ventricular communication associated with pulmonary atresia and ventricular septal defect.

THE GENESIS OF COMMUNICATIONS between the right ventricle and coronary arteries commonly associated with pulmonary atresia remains uncertain. Edwards' attributed the persistence of these communicating sinusoids to increased right ventricular pressure and emphasized the importance of right ventricular outflow obstruction, intact ventricular septum, and competence of the tricuspid valve. Other authors,2-5 based on the earlier work of Grant,6 have suggested that inadequate early right ventricular maturation fails to occlude the embryonic sinusoids which then persist as right ventricular to coronary artery fistulae. This report concerns a case in which pulmonary atresia, right ventricular-coronary artery fistulae, ventricular septal defect, and malformation of the tricuspid valve were all present.