Surgical correction of a coronary fistula between the left main coronary artery and the coronary sinus in a neonate

We present a rare case of a 6-day old female neonate with a particularly exceptional coronary anatomy encompassing a fistula between the left main coronary artery and the coronary sinus with steal phenomenon, mandating surgical correction. The condition is extremely rare with an estimated incidence of about 0.1-0.2%. We operated this girl early on to prevent ischaemic events and pulmonary overflow with future heart failure. Further, we discuss possible aetiology and pathophysiological mechanisms of coronary artery fistulae and steal phenomena. Depending on specific anatomic characteristics, an interventional approach may be an alternative for surgical closure; however, this was not possible in our case.