Coronary Artery Fistulas

1. 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 mediastinum.
2. 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 surgical findings.
3. 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 one case.
4. 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.
5. Caretta Q, Voci P, Bilotta F, Mercanti C. Intraoperative contrast echocardiography for assessment of the surgical repair of coronary artery fistula.
   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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