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Eur J Cardiothorac Surg 1999;16:364-366
© 1999 Elsevier Science NL

Case report

Intraoperative localisation and management of coronary artery fistula using transesophageal echocardiography

Isaac Kadir, Raimondo Ascione, Steven Linter, Alan J. Bryan

Bristol cardiothoracic Centre, Bristol Royal Infirmary, Bristol, UK

Corresponding author. Tel.: +44-117-928-3145; fax: +44-117-929-9737

Coronary artery fistula is a rare congenital malformation that can be complicated by intracardiac shunts, endocarditis, myocardial infarction, coronary aneurysm and sudden death. Clinical symptomatology depends upon the underlying anatomy and the size of the fistulous connection between the left or right side of the heart. We report the successful management of a giant right coronary artery with fistulisation into the right atrium. Intraoperative transesophageal echocardiography with colour flow Doppler was used for precise location of the fistulous communication, selective demonstration of vessels feeding the fistula and documentation of abolition of fistulous flow all without the need for cardiopulmonary bypass. Futhermore the effect of shunt occlusion on regional wall motion was documented which facilitated the successful ligation of the fistula.

Key Words: Coronary artery fistula • Transesophageal echocardiography • Without cardiopulmonary bypass




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Copyright © 1999 European Association for Cardio-Thoracic Surgery. Published by Elsevier. All rights reserved.