Coronary Artery Fistula

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Presentation transcript:

Coronary Artery Fistula Chirantan V. Mangukia, MBBS The Annals of Thoracic Surgery Volume 93, Issue 6, Pages 2084-2092 (June 2012) DOI: 10.1016/j.athoracsur.2012.01.114 Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A) Transthoracic color Doppler echocardiogram shows a continuous flow in the high parasternal short axis view, originating from a small entry site on the wall of the main pulmonary artery (arrow). (B) A selective left coronary angiography in the same patient shows a fistula connecting the proximal portion of the left anterior descending coronary artery (solid large white arrow) with the main pulmonary artery (clear arrow). The small three white arrows indicated drainage into the pulmonary circulation. (Reproduced from Quatrini, et al [43], which is an Open Access article published by BioMed Central and distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.) The Annals of Thoracic Surgery 2012 93, 2084-2092DOI: (10.1016/j.athoracsur.2012.01.114) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 (A) A very tortuous fistula is seen between the left anterior descending coronary artery and the right ventricle. (B) The fistula is closed by controlled-release coils. (Reproduced from Qureshi, et al [44], which is an Open Access article published by BioMed Central and distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.) The Annals of Thoracic Surgery 2012 93, 2084-2092DOI: (10.1016/j.athoracsur.2012.01.114) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 A volume-rendered computed tomography scan shows a large coronary artery fistula. (CD = right coronary artery (Spanish acronym from artéria coronária derecha); CX = circumflex; DA = descending artery; Dg1 = first diagonal branch; MgE1 = first marginal branch.) (Reproduced from Dourado LO, et al, Grande fístula bilateral da artéria coronária: a escolha do tratamento clínico. Arquivos Brasileiros de Cardiologia 2009;93:e48–e49 [46], with permission.) The Annals of Thoracic Surgery 2012 93, 2084-2092DOI: (10.1016/j.athoracsur.2012.01.114) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 (A) A fistula similar to type A (Sakakibara) is shown, in which the artery distal to the fistula appears normal. The same figure shows direct ligation of fistula (black arrow). (B) Pledgeted sutures are shown occluding the fistula beneath the coronary artery when direct ligation is not possible. (C) The side-to-side pattern of communication of this fistula is shown as schematic diagram. The Annals of Thoracic Surgery 2012 93, 2084-2092DOI: (10.1016/j.athoracsur.2012.01.114) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 (A) A fistula similar to type B (Sakakibara) is shown, in which the entire artery proximal to the fistula is dilated with normal branching. (B) A schematic diagram shows the end-to-side fistula. The Annals of Thoracic Surgery 2012 93, 2084-2092DOI: (10.1016/j.athoracsur.2012.01.114) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 (A) An arteriotomy wound is shown, exposing the fistulous opening from inside. (B) The sutured fistulous opening is shown. The Annals of Thoracic Surgery 2012 93, 2084-2092DOI: (10.1016/j.athoracsur.2012.01.114) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions