Intraoperative localisation and management of coronary artery fistula using transesophageal echocardiography

Area of Science:

• Cardiovascular Surgery
• Medical Imaging
• Congenital Heart Disease

Background:

• Coronary artery fistulas are rare congenital defects with potential complications like myocardial infarction and sudden death.
• Symptoms vary based on fistula anatomy and size, impacting cardiac function.
• Giant right coronary artery fistulas pose unique management challenges.

Observation:

• A case of a giant right coronary artery fistula to the right atrium is presented.
• Intraoperative transesophageal echocardiography with color flow Doppler precisely identified the fistula's origin and termination.
• The technique allowed for selective visualization of feeding vessels and confirmation of shunt abolition.

Findings:

• Successful surgical ligation of a giant coronary artery fistula was achieved.
• Transesophageal echocardiography guided precise localization and confirmed successful closure without cardiopulmonary bypass.
• Regional wall motion changes were monitored to ensure safe shunt occlusion.

Implications:

• This approach offers a minimally invasive strategy for managing complex coronary artery fistulas.
• Intraoperative echocardiography is crucial for accurate diagnosis and successful surgical intervention.
• Effective management can prevent serious complications associated with coronary artery fistulas.