Author + information
- Received May 25, 2015
- Accepted June 5, 2015
- Published online October 1, 2015.
- Po-Chi Liao, MD∗ (, )
- Shih-Rong Hsieh, MD∗,‡,
- Yu-Cheng Hsieh, MD, PhD∗,#,
- Si-Wa Chan, MD†,
- Kuo-Yang Wang, MD∗,§,‖,
- Yen Chang, MD∗,‡ and
- Wei-Wen Lin, MD, PhD∗,§,¶∗ ()
- ∗Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- †Department of Radiology, Taichung Veteran General Hospital, Taichung, Taiwan
- ‡College of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.
- §Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- ‖Department of Internal Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- ¶Department of Life Science, Tunghai University, Taichung, Taiwan
- #Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan
- ↵∗Reprint requests and correspondence:
Dr. Wei-Wen Lin, Cardiovascular Center, Taichung Veterans General Hospital, 1650 Taiwan Boulevard, Sect. 4, Taichung, 40705, Taiwan.
A 63-year-old woman was admitted to our hospital due to a grade III systolic murmur over the pulmonary area. A chest x-ray (Figure 1A) showed cardiomegaly with abnormal vascular shadow over the left atrium area. Transthoracic echocardiography showed coronary artery drainage into pulmonary artery, with continuous flow (Figures 1D and 1H, Online Video 1, 2, and 3), which suggested a coronary fistula. Both multiple detector computed tomography (MDCT) and cardiac catheterization (Figures 1B, 1C, and 1G, Online Videos 4 and 5) showed bilateral large coronary fistula from the proximal left anterior descending artery (LAD) conus branch and the RCA conus branch to the main pulmonary artery. Because of the large size of both the LAD and RCA fistula with heart failure, surgical intervention was arranged. Surgical ligation of the main feeding arteries from the LAD and RCA was performed. The pulmonary trunk defect and the fistula insertion sites were repaired using an autogenous pericardial patch. The postoperative course was uneventful. Three years later, follow-up MDCT and chest x-ray (Figures 1E and 1F) showed much smaller coronary pulmonary fistula with a decrease in heart size. Although transcatheter closure of coronary artery fistula is effective and safe, surgical ligation remains important in large and complicated vessels such as those described in the present case.
For the accompanying videos, please see the online version of this article.
The authors have reported that they do not have any relationships relevant to the contents of this paper to disclose.
- Received May 25, 2015.
- Accepted June 5, 2015.
- American College of Cardiology Foundation