Intraoperative fluorescence imaging during surgery for coronary artery fistula

A 45-year-old man had a history of myocardial infarction at one month prior to admission. Coronary angiography revealed a dilated fistula originating from the left anterior descending coronary artery to the pulmonary artery. Two orifices of the draining artery were closed through pulmonary arteriotomy. Ligation of the fistulous vessels was performed at three places to ensure complete closure of the fistula. Before and after the cardiopulmonary bypass, fluorescent dye angiography was performed with indocyanine green. Fluorescence imaging revealed complete closure of the fistula and no residual shunt flow. Postoperative coronary angiography revealed neither a residual fistula nor injury to the coronary artery.