Giant and aneurysmal left circumflex coronary fistula to coronary sinus-Cardiovascular computed tomography imaging...

Area of Science:

• Cardiology
• Medical Imaging
• Vascular Surgery

Background:

• Coronary artery fistula (CAF) is an abnormal connection between a coronary artery and a cardiac chamber or major vessel.
• Coronary artery aneurysms (CAAs) associated with fistulas are uncommon and pose diagnostic challenges.
• Accurate delineation of fistula anatomy and drainage is crucial for effective management.

Purpose of the Study:

• To report a case of coronary aneurysm associated with coronary fistula (CAACF).
• To highlight the diagnostic utility of electrocardiogram-gated 64-multi-detector computed tomography (MDCT) in complex coronary artery anomalies.
• To describe the successful surgical management of CAACF.

Main Methods:

• Transthoracic echocardiogram for initial cardiac murmur evaluation.
• Coronary angiography (CAG) to identify potential coronary artery fistula.
• Electrocardiogram-gated 64-multi-detector computed tomography (MDCT) for precise fistula drainage site and aneurysm characterization.
• Surgical ligation of the fistula and direct closure of the coronary aneurysm.

Main Results:

• Diagnosis of a left circumflex artery (LCX) to coronary sinus (CS) fistula with an aneurysm at the fistula termination.
• MDCT successfully identified the LCX-CS fistula drainage site and associated aneurysm, overcoming limitations of CAG.
• Successful surgical intervention with complete resolution of fistula flow confirmed by post-operative CAG and MDCT.

Conclusions:

• Coronary artery aneurysm associated with coronary fistula (CAACF) requires precise diagnostic imaging.
• Electrocardiogram-gated MDCT is a valuable tool for diagnosing and characterizing complex CAACF.
• Surgical management provides a definitive treatment option for CAACF with favorable outcomes.