Coronary arteriovenous fistula (CAVF) is defined as an abnormal communication between the coronary artery and a cardiac cavity or a major blood vessel. It is the most common congenital anomaly of the coronary arteries, but it is relatively rare, accounting for only approximately 0.4% of all congenital heart diseases. Most cases of CAVF are clinically asymptomatic in young patients, but with increasing age, symptoms begin to appear and surgical treatment is required. In rare cases of CAVF, however, symptoms may appear in the neonatal period and early surgery may be required. In this article, we report the case of a 12-day-old patient diagnosed after birth with CAVF between the aneurysmatic left anterior descending artery and the right ventricle. This patient required early surgical intervention due to concerns about worsening heart failure and developing coronary artery ischemia. Although various surgical options were considered, we opted for an arteriotomy of the left anterior descending artery and closed the fistula with two autologous pericardial patches. There has been no signs of postoperative ischemic changes or enlargement of the coronary aneurysm during the 4 years of follow up, and careful monitoring will continue.

A nine-month-old boy with a prenatal diagnosis of aorto-left ventricular tunnel (ALVT) and aortic valve disease underwent an urgent ALVT patch closure approximately 2 h after birth. The patient subsequently developed airway compression due to the progressive dilatation of the ascending aorta postoperatively associated with aortic regurgitation and stenosis. After 9 months of prolonged respiratory symptoms following the ALVT repair, he underwent a posterior plication of the ascending aorta. After plication, the tracheal compression and respiratory symptoms improved. A computed tomography (CT) scan 1 month after surgery revealed significant free space between the aorta and the trachea, which relieved the aortic compression. Posterior plication of the ascending aorta is achieved by resecting the posterior aortic wall adjacent to the airway. It is the procedure of choice for longer and more effective relief of airway compression compared to other procedures such as anterior aortopexy, the lateral sliding technique, and side clamp plication.

A male infant was diagnosed with aorto-left ventricular tunnel (ALVT) because of advanced left ventricular hypertrophy and massive reflux from the aorta to the left ventricle during the fetal period. Aorto-left ventricular tunnel closure was emergently performed 2 h after birth in cooperation with the hospital where he was born. The aortic end of the ALVT was located above the right-left coronary commissure, and the measured diameter was 8 mm. The aortic valve was tricuspid, but it was thickened and the opening was limited ; it was further complicated by a right coronary artery anomaly. Taking the valve distortion and surgical invasion into consideration, only the aortic end was closed using an autologous pericardial patch. Although mild aortic valve stenosis and regurgitation remained after surgery, the postoperative course was uneventful, and the left ventricular hypertrophy and cardiac function were improved.