What's already known about this topic?Coronary artery fistulas are rare anomalies with an incidence of 0.002% in the population. What does this study add?The association of tetralogy of Fallot, coronary artery fistulas, and agenesis of the ductus arteriosus has not been reported.The discrepancy between the narrow pulmonary annulus with thickened pulmonary valve and the large pulmonary trunk can be caused by extra blood supply through the large fistula.

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