Coronary Artery Fistulas
References on the role of transesophageal echocardiography:
Ritter M, Duewell S, Jenni R. Rare association of a coronary fistula with
a fusiform aneurysm of the superior vena cava: diagnosis via transesophageal
echocardiography and MRI.
Schweizerische Rundschau fur Medizin Praxis 1995 Sep 26;84(39):1068-70
A congenital fistula of the left circumflex coronary artery with
large aneurysmal sacculations and drainage into the vena cava
superior is reported in an asymptomatic black adult female. An
indicator dilution curve excluded a significant left-to-right shunt.
In addition, the patient had a large fusiform aneurysm of the
superior vena cava with maximal extension in the anterior upper
mediastinum. Transesophageal Doppler echocardiography and magnetic
resonance imaging were complementary diagnostic tools, the first for
clearly visualizing coronary anatomy and shunt, the second for
accurate imaging of the aneurysmal vena cava superior in the upper
Erlicher A, Zammarchi A, Pitscheider W, Giacomin A.
Transesophageal echocardiographic diagnosis of coronary fistula in
an adult patient].
Giornale Italiano di Cardiologia 1994 Feb;24(2):137-41
There are only a few reports about the utility of transesophageal
echocardiography (TEE) in diagnosing coronary artery fistulas. We
report a case of an adult patient with an unsuspected fistula
between the right coronary artery and the right atrium, which was
identified and correctly described by TEE. This diagnosis was
subsequently confirmed by selective coronary angiography and
Prewitt KC, Smolin MR, Coster TS, Vernalis MN, Bunda M, Wortham DC.
Coronary artery fistula diagnosed by transesophageal echocardiography.
Chest 1994 Mar;105(3):959-61
Coronary artery fistulas have been traditionally diagnosed by
angiography. This report describes a congenital and a traumatic
coronary artery fistula diagnosed by transesophageal
echocardiography. Transesophageal echocardiography was superior to
transthoracic echocardiography in both cases and to angiography in
Giannoccaro PJ, Sochowski RA, Morton BC, Chan KL. Complementary role of
transoesophageal echocardiography to coronary angiography in the
assessment of coronary artery anomalies.
British Heart Journal 1993 Jul;70(1):70-4
Coronary artery anomalies are difficult to detect
clinically. Most are benign but some may produce symptoms that can
be life threatening. Until recently the non-invasive assessment of
coronary artery anomalies has been limited. The data base
of transoesophageal echocardiographic studies performed between
September 1988 and April 1991 were reviewed to identify all cases of
coronary artery anomalies. There were six patients with such
anomalies who had also had coronary angiography. The findings of
these two imaging techniques were analysed to determine whether
transoesophageal echocardiography added useful data in these cases.
Of the six patients, the coronary anomaly was discovered
during angiography in four patients, during a transthoracic
echocardiographic study in one patient, and as an incidental finding
in the other patient. Aberrant origins of the left coronary artery
were detected in two patients, and coronary artery fistulae were
present in the other four. Transoesophageal echocardiography
provided unique information on the course of an aberrant left
coronary artery in one patient and the precise location of drainage
sites of coronary artery fistulas in three patients.
Transoesophageal echocardiography was complementary to
angiography in the assessment of coronary artery anomalies. It can
locate and delineate the course of an ectopic coronary artery and
the drainage site of a coronary fistula. These anatomical data can
be crucial to the management of these patients.
Caretta Q, Voci P, Bilotta F, Mercanti C. Intraoperative contrast
echocardiography for assessment of the surgical repair of coronary artery
European Journal of Cardio-Thoracic Surgery 1993;7(11):612-4
Two cases of acquired coronary fistula were evaluated intraoperatively
by contrast echocardiography.
Surgical repair was carried out through the left
atrium because of the associated surgical procedure on the mitral
valve. Contrast echocardiography allowed easy identification of the
fistula openings in the left atrium and intraoperative control of
the efficacy of the surgical closure.
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