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Eur J Cardiothorac Surg 2002;21:929
© 2002 Elsevier Science NL

Images in cardio-thoracic surgery

Giant right coronary artery-coronary sinus fistula

Franz X. Schmida*, Dietmar Elsnerb, Johannes Merka, Dietrich E. Birnbauma

a Department of Cardiothoracic and Vascular Surgery, University Hospital of Regensburg, Franz-Josef-Strauss Allee 11, D-93053 Regensburg, Germany
b Department of Cardiology, University Hospital of Regensburg, Franz-Josef-Strauss Allee 11, D-93053 Regensburg, Germany

Received 13 December 2001; accepted 31 January 2002.

* Corresponding author. Tel.: +49-941-944-9805; fax: +49-941-944-9802
e-mail: franz.xaver.schmid{at}klinik.uni-regensburg.de

Key Words: Coronary artery surgery • Coronary sinus fistula

A 42-year-old man was referred to our hospital for increasing dyspnoea and chest pain at exertion. Diagnostic investigations included echocardiography, cardiac catheterisation and angiography and demonstrated aneurysmal proportions of the right coronary artery (RCA) as well as a communication between the RCA and the right atrium. Analysis of oxygen saturations allowed calculation of a left-to-right shunt of 35% at atrial level. At operation a fistula was found originating in the giant RCA (Fig. 1A ) just distal to the crux cordis and terminating within the coronary sinus (Fig. 1B). Closure of the communication was undertaken by suture interruption of the fistula from the coronary artery and coronary sinus side. The patient's postoperative course was uneventful.



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  		Fig. 1. (A) Surgeons view of the giant RCA. Ao, aorta; RA, right atrium; RCA, right coronary artery. (B) Intraoperative view into the right atrium depicting a probe in the incised RCA and the fistula within the coronary sinus. TV, tricuspid valve; CS, coronary sinus; RCA, right coronary artery; RA, right atrium.

 



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