Right coronary artery-coronary sinus fistula diagnosed by three-dimensional echocardiography

Right coronary artery-coronary sinus fistula is a very rare congenital anomaly in which a right coronary artery fistula drains into the right atrium, right ventricle, or pulmonary artery. A right coronary artery-coronary sinus fistula was diagnosed in a 44-year-old man by three-dimensional echocardiography and confirmed by computed tomography angiography and surgery. Relevant published experience in diagnosing this kind of anomaly is summarized.     

Successful surgical repair of a giant left main coronary artery aneurysm with arteriovenous fistula draining into a persistent left superior vena cava and coronary sinus: role of intraoperative transesophageal echocardiography

We report the case of a 74-year-old woman with a history of hypertension, hypercholesterolemia, and pacemaker who presented to the hospital with new onset New York Heart Association class IV congestive heart failure. Transthoracic echocardiography revealed a markedly dilated right ventricle with normal right ventricular systolic function. There was moderate pulmonary hypertension with an estimated pulmonary artery systolic pressure of 60 mm Hg. Her echocardiogram 1 year earlier had demonstrated normal right ventricular size and systolic function, and no pulmonary hypertension. Additional transthoracic imaging with saline contrast study through a left peripheral vein demonstrated the presence of a dilated coronary sinus with a persistent left superior vena cava. Color Doppler demonstrated turbulent flow within the coronary sinus with evidence of significant left-to-right shunting. Cardiac catheterization revealed a massively dilated left main coronary artery aneurysm with an arteriovenous fistula into the left superior vena cava and coronary sinus. The calculated Qp/Qs was 2:1. The patient underwent 2 unsuccessful attempts at percutaneous intervention to occlude the arteriovenous fistula. She then underwent successful surgical closure of the coronary arteriovenous fistula. The important role of intraoperative transesophageal echocardiography in guiding this technically challenging surgical case is discussed.     

Coronary artery fistula: diagnosis by biplane transesophageal echocardiography.

A 56-year-old man underwent coronary angiography during evaluation of severe mitral regurgitation. A right coronary artery fistula was incidentally discovered but its site of termination was uncertain. Transthoracic echocardiography also did not reveal the location of its drainage. The correct diagnosis of a right coronary artery to left atrial fistula was made using biplane transesophageal echocardiography. This case demonstrates the utility of biplane transesophageal echocardiography in the diagnosis of the origin and termination of congenital coronary artery anomalies.     

Echocardiographic characterization of a rare type of coronary artery fistula draining into superior vena cava.

We describe an incidental finding of a rare type of anomalous coronary artery originating from the right coronary sinus of Valsalva and draining into the superior vena cava. This was suspected on transthoracic echocardiography but was further clarified with the use of coronary angiography and transesophageal echocardiography. Echocardiography was a major tool for delineating the origin of the fistula, its complicated course, and the drainage site.     

Heart failure due to giant congenital aorto-right atrial fistula: report of a case

Coronary arterio-venous fistula (CAVF) is a rare coronary artery anomaly. We demonstrated the rare findings of a large congenital aorto-right atrial fistula with initial presentation of heart failure symptoms. Transthoracic echocardiography and transesophageal echocardiography made the accurate diagnosis. Further haemodynamic and angiographic study proved this large CAVF with extraordinary oxygen saturation step-up (26%) and large pulmonary to systemic shunt (Qp/Qs = 4.25). It was corrected by surgery because of evidence of heart failure and the possible risk of endocarditis and coronary steal effect.     

A case of coronary artery fistula diagnosed in the right decubitus position by transthoracic echocardiography

A 70-year-old woman was admitted to our hospital for a continuous heart murmur in the fourth intercostal space at the right sternal border. Routine echocardiography demonstrated aneurismal dilatation at the origin of right coronary artery. These findings suggested a coronary artery fistula, although its drainage site could not be identified. By shifting the patient to the right decubitus position, we could observe an abnormal color Doppler signal going from the right coronary artery into the right atrium, confirming coronary artery fistula. The right decubitus position may be helpful for the evaluation of abnormal anatomic and auscultatory findings.     

Right coronary artery-to-right ventricle fistula complicating percutaneous transluminal angioplasty: case report and review of the literature.

This case report describes an iatrogenic right coronary artery-to-right ventricle fistula resulting from percutaneous transluminal coronary angioplasty. In this patient transthoracic echocardiography with Doppler color flow mapping allowed direct visualization of the right coronary artery aneurysm and the coronary fistula, enabling us to identify the cardiac chamber into which the fistula drained. Transthoracic echocardiography was used for follow-up of this patient, demonstrating spontaneous closure of the fistula within 3 months of the procedure. In addition, this article provides a brief overview of reported cases of percutaneous transluminal coronary angioplasty-induced coronary fistulae. The clinical course of this complication and therapeutic approaches presented in the literature are also briefly discussed.     

Fistulous communication between the right coronary artery and left atrium.

This report describes congenital coronary artery fistula of the right coronary artery draining into the left atrium in a young woman. The initial diagnosis of this rare anomaly was made noninvasively by echocardiography. Transesophageal echocardiography was vastly superior to transthoracic echocardiography in presenting the entire course of the fistula. The diagnosis was confirmed by coronary angiography. The fistula was successfully closed surgically.     

Precise evaluation of a complex coronary arteriovenous fistula: the utility of transesophageal color Doppler

The transesophageal color flow Doppler appearance of coronary artery fistulas have not been described previously. We present a patient with a fistulous connection between the right coronary artery and the right atrium with an additional connection to the coronary sinus. The fistulous connection to the coronary sinus, confirmed at operation, was only diagnosed with transesophageal color flow Doppler and missed on both transthoracic echocardiography and cardiac catheterization. In addition, intraoperative transesophageal echocardiography was extremely useful in confirming closure of both these fistulas, thus confirming a successful operative result.     

Transesophageal echocardiographic recognition of a fistula between a coronary artery and the left atrium.

A 58-year-old woman with a prosthetic mitral valve and an anomalous single coronary artery received transesophageal echocardiography and was found to have a coronary artery--to--left atrium fistula. Because of its superior imaging quality, transesophageal color Doppler method is a useful diagnostic procedure.     

超声心动图诊断左冠状动脉右房瘘5例

【】目的:分析左冠状动脉右房瘘的彩色多普勒超声心动图特征,探讨超声心动图对诊断左冠状动脉右房瘘的价值。方法：应用超声心动图的二维图像、彩色显像和频谱多普勒观察左冠状动脉右房瘘的解剖异常及心腔内异常高速血流。结果：超声心动图均可见解剖异常的左冠状动脉显著扩张,走行迂曲,全程追踪显示瘘管,并于心腔内可见异常双期连续高速分流频谱,与冠状动脉造影及手术结果相符。结论：超声心动图对左冠状动脉右房瘘的诊断有很高直观性及实用性价值     

Non-invasive diagnosis of a congenital coronary artery fistula

This report describes a large congenital coronary artery fistula of the left circumflex artery draining into the coronary sinus in a 46 year old woman. The fistula was initially diagnosed by cross-sectional and transesopha-geal echocardiography using multiplane probe. Additionally, the entire course of the fistula was visualised in electron beam tomography. Angiography confirmed echocardiographic and tomographic findings.     

Transesophageal echocardiography follow-up of patients undergoing replacement of the ascending aorta and aortic valve with a Cabrol procedure for chronic aneurysm and dissection.

OBJECTIVE: The purpose of this study was to assess the usefulness of transesophageal echocardiography to detect complications after a Cabrol procedure. METHODS: A total of 28 unselected patients (mean age 52.2 +/- 13.3 years; 86% male) who survived a Cabrol procedure were examined with transesophageal echocardiography at a mean of 64 +/- 32 postoperative months. Underlying diagnosis was Stanford type A dissection in 11% of the patients and nondissecting aneurysm in 89%. RESULTS: Periprosthetic jet as a result of a valve leakage was demonstrated in 3 patients (11%). In 1 patient (4%) with infected aortic graft, a fistula between the periprosthetic space and the right ventricle was detected, requiring reoperation. One patient (4%) showed a complete occlusion of the graft limb of the right coronary artery but did not need reoperation. An aneurysm of the periprosthetic space with perivalvular leakage and persistence of periprosthetic right atrial fistula was visualized in 3 patients (11%). CONCLUSIONS: Our findings encourage the use of transesophageal echocardiography for the follow-up of patients undergoing a Cabrol operation.     

彩色多普勒超声心动图对冠状动脉瘘的诊断价值

目的探讨彩色多普勒超声心动图在冠状动脉瘘诊断中的价值。方法回顾分析2004~2009年11例冠状动脉瘘的超声心动图的声像图表现。结果受累冠状动脉明显扩张,11例冠状动脉瘘中,右冠状动脉瘘8例,左冠状动脉瘘3例。结论彩色多普勒超声心动图对冠状动脉瘘的诊断准确、快捷,可作为首选影像学检查方法。     

Prenatal diagnosis and perinatal management of left coronary artery to right atrium fistula.

Serious complications due to coronary artery fistulae have been described. Most authors recommend early intervention at the time of diagnosis. We present a case of a fistula originating from a dilated left coronary artery and draining into the right atrium, which was diagnosed prenatally by color Doppler echocardiography. During pregnancy, the echocardiographic findings remained unchanged, and there were no signs of heart failure. After birth, the fistula was confirmed by angiography. Additionally, a persistent left superior vena cava draining into the coronary sinus and a very small ventricular septal defect were detected. The fistula was closed successfully by transcatheter coil embolization. At 17 months old the child was in good clinical condition. Prenatal diagnosis of coronary artery fistulae may be possible and may improve perinatal management and outcome.     

Lipoma of the right atrium

A 66-year-old asymptomatic woman was admitted to our hospital with the diagnosis of a right atrial mass detected on an outside transthoracic echocardiogram and confirmed on transesophageal echocardiography. Physical examination and basal electrocardiogram were normal. Transthoracic echocardiography revealed a 3.8 x 2.5 cm echogenic mass in the right atrium. A multislice CT examination demonstrated a right atrial mass with a fat density ranging from -80 to -110 HU. The patient had a successful surgical excision of the mass, and the diagnosis of lipoma was confirmed on histopathological examination.     

Contrast transesophageal echocardiographic demonstration of coronary artery fistula within left atrial appendage thrombus in mitral stenosis.

Coronary neovascularization and fistula formation arising from the left circumflex artery demonstrated by coronary angiography is a specific sign for the presence of left atrial appendage thrombus in patients with mitral stenosis. However, the fistula drainage site in the left atrium in relation to the thrombus cannot be ascertained by the angiographic method. We performed transesophageal echocardiography simultaneously with coronary angiography in five patients with severe mitral stenosis and left atrial appendage thrombus. The angiography showed coronary neovascularization and fistula arising from the left circumflex artery in three patients. In these three patients, the transesophageal echocardiography confirmed the presence of a coronary fistula by identifying contrast exuding from the surface of the thrombus. Thus we have shown for the first time the usefulness of contrast transesophageal echocardiography in imaging the exact drainage site of coronary artery fistula from left atrial appendage thrombus.     

彩色多普勒超声诊断冠状动脉-心腔瘘的图像特征分析

目的 探讨彩色多普勒超声诊断冠状动脉－心腔瘘的图像特征。方法 应用彩色多普勒超声的二维图像,多普勒频谱和彩色显像对10例冠状动脉心腔瘘的多种解剖异常进行观察。结果 彩色多普勒诊断的共同特征是：冠状动脉局部扩张,其中7例为右冠状动脉增宽,1例为左冠状动脉主干增宽,2例为左冠状动脉回旋支增宽;心腔内出现异常相对高速度血流,为瘘管血流入心腔所造成,其中漏入左室6例,入右 2例,入右室流出道1例,入冠状静脉1例;右安然无恙太动脉瘘管常沿右房室交界纡曲走行,左冠状动脉瘘管常沿左房室交界走行,局部可见瘘管的断面,介绍2例合并较大动脉瘤的超声图像。结论 彩色多普勒超声诊断冠状动脉－心腔瘘具有很好的直观性和实用性。     

先天性冠状动脉瘘的影像学诊断

目的：研究动脉造影对先天性冠状动脉瘘的价值及结合文献分析及其病理解剖。材料与方法：先天性冠状动脉瘘6例,男4例,女2例,年龄5－55岁,平均28．3岁,6例患者均行彩色多谱勒,X线片及动脉造影检查;3例行外科手术治疗。结果：动脉造影发现右冠状动脉右室瘘2例,右冠状动脉右房瘘1例,左冠状动脉右房瘘1例,左冠状动脉左房瘘和左冠状动脉冠状静脉瘘各1例,结论：先天性冠状动脉瘘临床表现无特征性,动脉造影是对该病诊断的可靠方法,彩色多谱勒及X线片为该病的辅助诊断方法。     

Asymptomatic dissection of the ascending aorta: diagnosis by transesophageal echocardiography

A young man with marfanoid habitus underwent transesophageal echocardiography to evaluate an aortic root abnormality visualized on transthoracic echocardiography. Transesophageal echo demonstrated a type A aortic dissection traversing across the right sinus of Valsalva but not involving the aortic valve, right coronary artery, or pericardial sac. The aorta was not dilated. This is apparently the first reported case of an asymptomatic and uncomplicated aortic dissection localized to the sinus of Valsalva.