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Eur J Cardiothorac Surg 2007;32:933. doi:10.1016/j.ejcts.2007.08.027
Copyright © 2007, European Association for Cardio-thoracic Surgery. Published by Elsevier. All rights reserved.
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Images in cardio-thoracic surgery

Right coronary artery fistula into left ventricle: dynamic compression shown by multislice computed tomography

Gudrun Feuchtnera,*, Daniel Junkera, Johannes Bonattic, Guy Friedrichb

a Department of Radiology II, Innsbruck Medical University, Anichstr. 35, A-6020 Innsbruck, Austria
b Department of Cardiology, Innsbruck Medical University, Innsbruck, Austria
c Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria

Received 2 July 2007; received in revised form 23 August 2007; accepted 24 August 2007.

* Corresponding author. Tel.: +43 512 504 81898; fax: +43 512 504 24029. (Email: Gudrun.Feuchtner{at}i-med.ac.at).

Key Words: Coronary fistula • Left ventricle • Multislice computed tomography • Imaging • Coronary artery disease

A 44-year-old male with inferior-posterior myocardial ischemia during ECG stress test was referred to 64-slice computed tomography (CT). CT showed a right coronary artery (RCA) fistula draining into the left ventricle (Fig. 1 , Video 1) with dynamic compression of the fistula orifice during systole (Fig. 2 ). CT provides helpful information about fistula location and length before surgery.


Figure 1
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  		Fig. 1. Mega-right coronary artery (RCA) (A) draining into the left ventricle (B) via the posterior myocardium (white arrow) is shown 3D with multislice computed tomography by applying volume-rendering technique (VRT).

 

Figure 2
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  		Fig. 2. Retrospective ECG-gated image reconstruction by multislice CT showed the fistula open during end-diastole (A) and narrowing of the inner fistula orifice during end-systole (B) due to compression by the myocardium. The inner fistula orifice is located close to the mitral valve (MV) annulus. The RCA had a tortuous ‘8-shaped’ course before its entrance into the left ventricle (white arrow) (C).

 
Appendix A

Supplementary data

Supplementary data associated with this article can be found in the online version at doi:10.1016/j.ejcts.2007.08.027.




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