Transesophageal echocardiography, more than a diagnostic tool: use during surgical ligation of coronary artery fistulae - a case report

Journal of Cardiothoracic Surgery

Kuen-Bao Chen¹  Yu-Fang Liu²  Pai-Ching Huang²  Ping-Chen Chung² 

[1] College of Medicine, China Medical University, No.91 Hsueh-Shih Road, Taichung, Taiwan 404, Taiwan, R.O.C;Department of Anesthesia, Pain Service, and Critical Care Medicine, China Medical University Hospital, No. 2, Yuh-Der Road, Taichung 404, Taiwan, R.O.C

关键词: transesophageal echocardiography (TEE);    intraoperative;    Coronary artery fistulae (CAF);   

Others  :  1153315
DOI  :  10.1186/1749-8090-7-28

 received in 2011-08-25, accepted in 2012-04-06,  发布年份 2012

【 摘 要 】

Coronary artery fistulae (CAF) are an infrequent coronary abnormality. Herein, we describe the use of intraoperative transesophageal echocardiography (TEE) in the treatment of CAF. A 61 year-old woman presented with chest pain and symptoms consistent with unstable angina. Subsequent coronary angiography revealed the presence of 2 CAF, one extending from the left anterior descending artery to the pulmonary artery (PA) and the other extending from the proximal right coronary artery to the PA. Surgical ligation of the CAF without coronary bypass was arranged. Intraoperative TEE was successfully employed to localize the CAF, monitor fistula blood flow and heart wall motion, and confirm successful ligation. The patient recovered without complications. This case highlights the utility of intraoperative TEE during ligation of CAF.

【 授权许可】

   
2012 Chung et al; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Gillebert C, Van Hoof R, Van de Werf F, Piessens J, De Geest H: Coronary artery fistulas in an adult population. Eur Heart J 1986, 7:437-443.
• [2]Vavuranakis M, Bush CA, Boudoulas H: Coronary artery fistulas in adults: incidence, angiographic characteristics, natural history. Cathet Cardiovasc Diagn 1995, 35:116-120.
• [3]Gowda RM, Vasavada BC, Khan IA: Coronary artery fistulas: clinical and therapeutic considerations. Int J Cardiol 2006, 107:7-10.
• [4]Giannoccaro PJ, Sochowski RA, Morton BC, Chan KL: Complementary role of transoesophageal echocardiography to coronary angiography in the assessment of coronary artery anomalies. Br Heart J 1993, 70:70-74.
• [5]Lowson SM, Danner JH, Dent JM, Rich GF: Transesophageal echocardiography in the diagnosis and management of a coronary artery fistula. Anesth Analg 1996, 83:1117-1119.
• [6]Kadir I, Ascione R, Linter S, Bryan AJ: Intraoperative localisation and management of coronary artery fistula using transesophageal echocardiography. Eur J Cardiothorac Surg 1999, 16:364-366.
• [7]Makaryus AN, Kort S, Rosman D, Vatsia S, Mangion JR: 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. J Am Soc Echocardiogr 2003, 16:1322-1325.
• [8]Iida R, Yamamoto T, Kondo N, Suzuki T, Saeki S, Ogawa S: Identification of the site of drainage of left main coronary artery to right atrium fistula with intraoperative transesophageal echocardiography. J Cardiothorac Vasc Anesth 2005, 19:777-780.
• [9]Iida R, Yamamoto T, Suzuki T, Saeki S, Ogawa S: The usefulness of intraoperative transesophageal echocardiography to identify the site of drainage of coronary artery fistula. Anesth Analg 2005, 101:330-331.
• [10]Sawai T, Miyazaki S, Nakahira J, Ito M, Oka M, Tanaka M, Imanaka H, Minami T: Intraoperative transesophageal echocardiography enables characterization of coronary artery fistula in coexistence with multiple giant coronary artery aneurysms. Anesth Analg 2008, 106:1104-1106.
• [11]Lin FC, Chang HJ, Chern MS, Wen MS, Yeh SJ, Wu D: Multiplane transesophageal echocardiography in the diagnosis of congenital coronary artery fistula. Am Heart J 1995, 130:1236-1244.
• [12]Kimura M, Shiraishi J, Ito D, Anyoshi M, Matsui A, Arihara M, Irie H, Hyogo M, Shima T, Kohno Y, Sawada T, Matsubara H: Usefulness and limitation of transthoracic echocardiography in the diagnosis of large coronary artery fistula. Echocardiography 2010, 27:1291-1295.
• [13]Velvis H, Schmidt KG, Silverman NH, Turley K: Diagnosis of coronary artery fistula by two-dimensional echocardiography, pulsed Doppler ultrasound and color flow imaging. J Am Coll Cardiol 1989, 14:968-976.
• [14]Stevenson JG, Sorensen GK, Stamm SJ, McCloskey JP, Hall DG, Rittenhouse EA: Intraoperative transesophageal echocardiography of coronary artery fistulas. Ann Thorac Surg 1994, 57:1217-1221.
• [15]Armsby LR, Keane JF, Sherwood MC, Forbess JM, Perry SB, Lock JE: Management of coronary artery fistulae: Patient selection and results of transcatheter closure. J Am Coll Cardiol 2002, 39:1026-1032.
• [16]Schamroth C: Coronary artery fistula. J Am Coll Cardiol 2002, 53:523.