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Updated: Apr 29, 2026
Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
Published on: March 27, 2018
Surgical procedure for coronary artery ectasia associated with saccular fistula
Masanori Murakami1, Hidenori Gohra1, Takeshi Yagi1
1Department of Surgery, Saiseikai Yamaguchi General Hospital.
Insights
A coronary artery fistula, a rare heart condition, was diagnosed in a 60-year-old woman. Surgical intervention successfully closed the fistula and reduced the aneurysm.
Area of Science:
- Cardiology
- Vascular Surgery
Background:
- Coronary artery fistulas are uncommon congenital or acquired abnormalities where a coronary artery connects directly to a heart chamber or another vessel.
- A persistent heart murmur can be an indicator of underlying cardiac anomalies, including coronary artery fistulas.
Observation:
- Echocardiography and coronary angiography revealed right coronary artery ectasia and fistula in a 60-year-old woman with a three-year history of heart murmur.
- A significant left-to-right shunt (29%) and a pulmonary-to-systemic blood flow ratio of 1.4 were noted.
- Follow-up revealed the development of infective endocarditis on the tricuspid valve, successfully treated with antibiotics.
Findings:
- The right coronary artery showed diffuse dilation and a saccular aneurysm distally.
- Additional fistulas from the left anterior descending and left circumflex arteries draining into the right ventricle were identified.
- The patient underwent successful fistula closure and reduction aneurysmectomy.
Implications:
- This case highlights the importance of thorough cardiac evaluation for persistent heart murmurs.
- Prompt diagnosis and management of coronary artery fistulas are crucial to prevent complications like infective endocarditis and heart failure.
- Surgical intervention can be effective in treating complex coronary artery fistulas with aneurysmal changes.
Abstract:
Echocardiography of a 60 year-old woman with a three-year history of heart murmur revealed a coronary artery fistula. Coronary angiography indicated right coronary artery ectasia and fistula. The pulmonary-to-systemic blood flow ratio was 1.4, and left-to-right shunt, 29%. On follow-up, infective endocarditis of the tricuspid valve had developed and was treated using antibiotics. The right coronary artery was dilated along its length and was saccular at the distal aspect. At this point, a fistula also connected by the left anterior descending and left circumflex arteries drained into the right ventricle. Fistula closure and reduction aneurysmectomy were performed.
