Off-pump resection of a coronary arterial fistula using the Harmonic Scalpel

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Medical Imaging

Background:

• Post-infarction angina can present with complex complications.
• Coronary artery fistulas, especially aneurysmal types, pose surgical challenges.
• Accurate localization of aberrant vessels is critical for successful intervention.

Observation:

• A patient with post-infarction angina had an aneurysmal coronary-pulmonary arterial fistula.
• Standard methods (visual inspection, palpation, TEE) failed to identify the fistula's feeding artery.
• Epicardial echocardiography precisely located the feeding artery within the myocardium.

Findings:

• Off-pump coronary artery bypass grafting and aneurysmectomy were performed.
• The Harmonic Scalpel facilitated dissection and ligation of the feeding arteries.
• Immediate cessation of fistula flow and successful, bloodless aneurysmectomy were achieved.

Implications:

• Epicardial echocardiography is invaluable for complex cardiac anomaly diagnosis.
• Minimally invasive techniques can effectively manage challenging coronary fistulas.
• This case highlights successful surgical management of a rare coronary-pulmonary artery fistula.